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Author: 



Binder, Rudolph Michael 



Title: 



Health and social 
progress 

Place: 

New York 

Date: 

1920 



qs-'^?>o3a-i 



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lousiness 
268 

B61 



Binder, Rudolph Michael, 

Health and social progress by Rudolph M, 
••• New York, Prentice- Hall, 1920. 

xi, 295 p. 19i- cm. 

Bibliography: p. 287-291. 



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HEALTH AND SOCIAL 

PROGRESS 



BY 



RUDOLPH M. BINDER, PH.D. 

Professor of Sociology, 
New York University 



New York 

PRENTICE-HALL, INC. 
J920 






CorvBiGBT. 1920 

Bt prentice-hall. Im. 






A NON-MEDICAL BOOK 

Dedicated to the Medical Profession 

The only one which has never used its knowledge for 
inflicting wounds on Mankind, but always for healing 
them; and is now to an ever-increasing extent applying 
that knowledge to the prevention of disease and the 
promotion of Health and Happiness. 



3^1 



<w* 



Man's rise from the level of the animal to that of 
a civilized human being has been due chiefly to his 
own efforts. While he depended on nature at first, 
owing to his limited intelligence, he rose higher in pro- 
portion as he used his mind in making it his servant. 
Proofs to this effect are accumulating every day. Qi- 
mates which were deadly once, are now becoming fruit- 
ful places for his enterprise. Fears which once terrorized 
him have been relegated into the realm of superstition. 
Diseases which once were deemed unavoidable now yield 
to scientific treatment. In the air and in the water, from 
the Arctic to the Antarctic, from the cradle to the grave, 
he becomes increasingly the master of nature and of 
his own fate. 



CONTENTS 



CBAriBK 



Preface 



rAGB 

1 



PART I 

I. Introduction 3 

II. Meaning of Health 15 

III. Health and Religion 32 

IV. Factors of Health 43 

V. Health and Civilization .... 53 



PART II 

VI. Health and Ancient Greece ... 81 

VII. Health and Ancient Rome . . . 106 
VIII. Effects of III Health on the Classical 

World ........ Ill 

IX. Health and the Tropics .... 124 

X. Health and World- Progress . . . 142 

XI. Health and World- Progress (Continued) 178 

XII. Health and World- Progress (Concluded) 208 

XIII. Health and Originality .... 241 

XIV. Results and Prospects .... 272 
Index 293 



PREFACE 

The population of the earth in 1800 was approximately 
600,000,000; in 1900, it was about 1,600,000,000— an in- 
crease of nearly 270 per cent. If, during the twentieth 
century, there should be a similar increase — ^and the indi- 
cations are all in that direction— the population in the 
year 2000 will be about 4,320,000,000. The question 
arising then will be. Where shall we get food? 

The time will not even then have arrived when, accord- 
ing to Fourier, our scientists will be able to turn the 
rocks of our mountains into bread and cakes, or the 
brine of the oceans into most delicious lemonade. The 
question will have to be faced in a matter-of-fact way 
instead of dreaming about it in a romantic fashion. 

Roughly speaking, two forms of answers have been 
given— that of the pessimist and that of the optimist. 
Among the pessimists we may reckon all those whose 
profession or attitude compels or inclines them to look 
backward. They have paid a heavy price for doing so, 
since no one can look into the past constantly without 
getting a wry neck and having his thought twisted. These 
people gloomily predict an increasingly more severe 
struggle, since, if it is only with the utmost difficulty that 
the present population maintains itself, what must happen 
if the population is nearly three times as large? Civiliza- 
tion will be doomed, or be confined to a few favored 
spots ; anarchy will prevail, and the second state of man- 
kind will be infinitely worse than the first, because men 
have learned how to do more harm than ever before. 
The optimist believes in human nature. He, too, looks 

i 



u 



PREFACE 



backward, but his eye is not glued to the past. True, 
things are bad; but the study of the past has taught 
him that they were worse before. 

Man has not only evolved, he has developed. His 
struggles in the past have taught him the all-important 
lesson of cooperation. He is not dismayed by a growing 
population, because he finds that men in 1900 are better 
fed and clad, more sympathetic and helpful to each other 
than they were in 1800. Density of population is a 
purely relative term. There were never more than 
1,000,000 Indians in the territory now occupied by the 
United States. Yet, the few Indians found the land too 
small, and waged constant wars for hunting grounds. 
The hundred million Americans are on the whole satis- 
fied, and engage only in wars of words about the best 
methods of improving things. 

The optimist believes with good reason that with 
increasing intelligence and good will, problems will be 
solved as they arise. But more than that. He tries to 
shape events in such a manner that they shall produce 
certain results. And he points to the achievements of 
man in the past and present, and confidently hopes that 
more will be accomplished in the future. 

In other words, the difference is that between the 
believer in the supremacy of natural law and the student 
of it for the purpose of utilizing it. The animal and the 
savage are subject to natural law, civilized man has 
liberated himself from it to a considerable extent by 
studying it. And he hopes that with a more intimate 
knowledge of nature he will construct a social system 
and build up a civilization, which will be able to support 
a very much larger population in a better manner than 
at present. 

Man has always conquered when he has gone to work 



PREFACE 



••• 
m 



intelligently and persistently about a problem. Only when 
he believed that some natural force was superior to him, 
was he defeated. Our whole civilization is unnatural in 
the sense that it has been wrung from parsimonious 
nature by the persistent application of human intelligence. 
To believe that with increasing knowledge we should be 
less capable of solving our problems, would mean to 
despair of ourselves and condemn our whole development. 
The scientist may say with justice that he is not con- 
cerned with the whither of his findings, that the facts 
alone matter, irrespective of whether they are encourag- 
ing or discouraging. That is true ! But he must then 
take a sufficiently large number of facts into considera- 
tion. Psychic experiences are facts as much as rain 
and sunshine. The will to conquer is as important as the 
natural fertility of a valley. Just because civilization 
has been largely determined in the past by natural condi- 
tions, is no reason why it should always be so. If the 
tropics have been uninhabitable in previous ages owing 
to certain diseases or climatic conditions, we need not 
despair of making them serviceable to the teeming mil- 
lions of the future. 

This brings us back to our original question. Where 
are the billions of the future to get their food? We have 
pushed north nearly as far as we can go. Ice-clad 
Siberia and snow-bound Alaska are giving us their 
products in food and minerals. But we shall soon have 
to turn south to the tropics, where nature rewards even 
the most inefficient labor with rich harvests. And the 
problem will arise, how are we going to conquer that 
vast territory from whence a large amount of our food 
must come ? In the past man had no solution, because he 
was both ignorant and cowardly. And his ignorance has 
exerted a vast influence upon the history of civilization. 



I 



iv PREFACE 

It was chiefly in the line of protecting himself against 
certain diseases that he was deficient. We have just 
begun to master these, and with this mastery the con- 
quest of the tropics is certain. Health, in other words, 
has been the most important factor in the development 
and extension of civilization. 

In looking beneath the surface of historic events we 
find that only those nations which enjoyed at least fair 
health, have been able to make some permanent contri- 
bution to the welfare and enlightenment of their con- 
temporaries and of future generations, because they alone 
had sufficient energy to procure more than the immediate 
necessaries for themselves. Other nations merely ex- 
isted; and in many cases we know of them only through 
their contact with the healthy and vigorous peoples who 
usually had no difficulty in enslaving them. 

It would be impossible to treat the effects of every 
disease known to modem medicine upon the nations of 
the past. An interesting book might be written about the 
influence of tuberculosis on civilization, especially since 
people began to gather in cities. The so-called "social 
diseases" have undoubtedly played a large role in the 
fall of Egypt, Greece, and Rome. But these diseases, 
widespread as they were, affected after all only indi- 
viduals, and not whole populations. They could, more- 
over, be guarded against by living in the open air and by 

living a moral life. 

Two diseases— malaria and hookworm—have accord- 
ingly been selected for showing the influence of poor 
health upon many races. They have always existed in 
historic times at least, and have been a drawback to by far 
the majority of the people living in the tropics, sub- 
tropics and the lower latitudes of the temperate zones. 
Estimates place the number of people living today in the 



PREFACE w 

malaria and hookworm zones at approximately one bil- 
lion. These diseases have been endemic in this large area 
from times immemorial, and are responsible for the low 
vitality prevailing in those regions. Being endemic, there 
was but little chance for anyone in that territory to escape 
their ravages. Three factors favored the practically un- 
checked course of these diseases. 

In the first place, but few people died directly as a 
result of contracting one or both of them ; thus little was 
done by men to protect themselves against an attack, as 
they did, however inadequately, against epidemics. In the 
second place, there was the general religious and philo- 
sophical tendency of the people to look upon diseases 
of any kind as a visitation from some deity whose wrath 
had been provoked by their disobedience. In the third 
place, these people had in the vast majority of cases no 
idea of the true nature of disease and, consequently, no 
conception of how to cure and prevent it. The specific 
for malaria— quinine — has been known to Europeans only 
since the seventeenth century, and the knowledge of its 
curative properties is even now confined to civilized 
peoples. There was, therefore, no escape for individuals 
and races living in the infested territories. 

With the beginning of the twentieth century an entirely 
new page opened in the history of mankind, for we not 
only know now the nature of these and other diseases, but 
also the remedies to cure and the means to prevent them. 
We have learned, moreover, that health and long life, 
which were looked upon as gifts of the gods, are matters 
having a relation to cause and effect, and are dependent 
on the proper observance of hygienic rules and on the 
establishment of sanitary precautions. There is no 
lonn^er any excuse now why there are probably at all 
tm^ 3,000,000 people ill in the United States, making 



▼1 



PREFACE 



an average of thirteen days of illness per annum for each 
inhabitant, or why 600,000 persons should die prema- 
turely from preventable diseases. This means not only a 
tremendous economic loss, but much needless suffering 
for both the patients and their families. 

Of other bearings on good health, mention need only 
be made of the fact that any other gift or talent we may 
have, loses much of its power to make us happy if our 
health is below normal. A man may have the wisdom of 
Solomon, but with poor health his usefulness is reduced 
one-half. A few men of exceptional ability have done 
valuable work notwithstanding poor health; they were, 
however, surrounded and assisted by others who took 
every burden off their shoulders. This was the case 
with Herbert Spencer and Charles Darwin. Of what 
value good health would have been to these men, they 
themselves have repeatedly and emphatically expressed. 

The view that there is generally a close connection be- 
tween poor health and low morals is becoming more 
permanently established on the basis of scientific investi- 
gations. A better and more intelligent pursuit of health 
would, consequently, assist in solving some of our moral 
problems. 

Another case may be mentioned. During the winter of 
1913-14 New York and other large cities had many un- 
employed men and women. A careful examination of 
2,000 of these men in the Municipal Lodging House of 
New York brought out the fact that about seventy-five 
per cent of them were below the normal in health, not 
as a result of exposure or chronic starvation, but of poor 
constitution. During the winter of 1914-15 an estimated 
number of unemployed of 400,000 resulted in the creation 
of a committee on unemployment, headed by the Mayor 
end some of the most influential business men. Very 



PREFACE 



vu 



little has been heard of its efficiency in procuring jobs for 
these people. But if the total percentage of low-vitality 
men among these " out-of-works " should be only fifty 
per cent — reckoning those in the municipal lodging house 
to have constituted the lower strata of the unemployed — 
it would seem rather useless to provide jobs for people 
who cannot hold them. Many men are unemployable not 
because they are unwilling to work but simply because 
their vitality is too low to stand the strain of regular 
application to work. It would seem that an investigation 
into the physical fitness of these people would be getting 
nearer the root of the trouble than more or less futile 
attempts to procure work for them which after a few 
brave but vain efforts they cannot perform. There is 
always a large amount of unemployment during the 
winter, owing to season work and other causes. But the 
healthy worker will save a little during employment, his 
lodge and his friends will help him out, and under normal 
conditions he is able to tide over the winter. Only when 
abnormal industrial conditions swell the number of the 
unemployables by large numbers of healthy employables, 
does the situation become acute. If the low-vitality men 
and women should number only 200,000 in New York 
City, the inference seems justified that they are supported 
by their families all the time, and are thus responsible 
for the depressed financial condition of these families. 
This inference is borne out by a study of the One 
Hundred Neediest Cases of New York, published by the 
Times for several years. An analysis of these cases 
shows that fully fifty per cent of them are due either 
directly to disease or to low vitality. Better attention to 
health and sanitation would tend to solve this problem to 
a considerable extent. 
Our educational systems are failing to meet the ex- 



rm 



PREFACE 



PREFACE 



IX 



pectations of the more advanced members of the com- 
munity, especially those of physicians, because they at- 
tempt to convey much useless information to children 
whose prime need is better health. The British govern- 
ment spends about i 15,000,000 a year on education. In 
many of the colonial schools colored children, suffering 
from malarial enlargement of the spleen, are taught the 
dates of the succession of the Plantagenet Kings, while 
little or nothing is done for their health. Other countries 
are doing more in this direction, notably Sweden, 
Germany, and the large cities of America. The culture 
of health has, however, nowhere been given the central 
position which it should occupy in a rational educational 
S3rstem. Yet that is necessary for a wholesome national 
development 

That this statement is true may be inferred from the 
facts presented herewith. 

Dr. S. Josephine Baker published the following statis- 
tics in The Ladies' Home Journal, for May, 1918 (page 
89). 



" There are in the schools of the United States today approxi- 
mately 20,000,000 pupils. It is estimated that : 

''300,000 to 400,000 of these have organic heart disease. 

** 1,000,000 at least have now, or have had, tuberculous disease 
of the lungs. 

" 1,000,000 have spnial curvature, or are flat footed, or have 
some other deformity serious enough to interfere to some 
degree with health. 

** 1,000,000 have defective hearing. 

"5,000,000 have defective vision. 

"5,000,000 are suffering from malnutrition, in many cases due 
in part at least to one or more of the other defects enumerated. 

** 6,000,000 have enlarged tonsils, adenoids, or enlarged cervical 
glands which need attention. 

10,000,000 (in some scholi at high as 98 per cent) have 



i< 



defective teeth which are potentially if not actually detrimental 
to health. 

"Several millions of the children possess, each, two or more 
of the handicapping defects. 

" 15,000,000 of the school children in this country are in need 
of attention today for physical defects which are partially or 
completely remediable." 

For New York City, >ve have the following data : — In 
1917, 247,735 children were examined by school 
physicians; 86,311 of these were found to suffer from 
various defects; 104,587 were found to suffer from de- 
fective teeth exclusively. This makes a total of 190,898, 
—certainly a very hi|^ percentage of the children ex- 
amined. 

The cost of health supervision of the children In the 
schools of New York was 42 cents per child in 1915. 
This is a very small amount of the total per capita cost 
of educating a child, which is $40 per year. 

These few figures show that we are not spending nearly 
as much on health in our schools as we should. 

Much of the perverse thinking and acting both among 
children and among adults is undoubtedly due to low 
vitality, or actuaLphysical defects. A brain that is poorly 
nourished readily becomes the host of all kinds of wild 
ideas and the country has to pay for it in various forms 
of expenditure for these misfits in society. 

The importance of one of the diseases considered in 
this book has been brought home to our generation by 
two facts of the present world war — the Allied Army in 
Macedonia, and the building of the cantonments of the 
American National Army. 

Considerable surprise, if not annoyance, has been ex- 
pressed at the comparative inactivity of the army in 
Macedonst, coniiiting of aoDroximatiav 750,000 men. 



X PREFACE 

Measured by what has happened on other fronts of the 
world war, this army has done practically nothing. Sur- 
mises of every possible nature have been advanced as an 
explanation for this lack of activity. Those who were in 
that field knew the reason, but it seemed hardly credible 
to people not familiar with the ravages of malaria. Lest 
the author be accused of exaggerating, a quotation from 
a man who has studied these conditions will be given in 
order to show that the most dangerous enemy of that 
army was neither the Turk nor the Bulgar, but the 
malaria-bearing mosquito. Herbert Corey gives the fol- 
lowing description of the effects of this endemic disease 
in the National Geographic Magazine for May, 1917. 

" the malaria-bearing mosquito is a really dangerous en- 
emy. Last year the Allied troops did not realize what the 
Macedonian mosquito can do, apparently. They were not pre- 
pared. In consequence fully one-half of their strength was 
out of action because of malaria. 

"During one period more men were invalided home than 
arrived on ships. I heard of battalions with 75 per cent of 
their men on their backs, and of companies in which only five 
men were fit for duty." 

It will take time and skill to remove this enemy, because 
Macedonia is malaria-ridden, just as Greece is today and 
has always been since the time of Pericles. 

For the cantonments of our National Army the best 
sites available from the point of view of health and 
sanitation were selected in 1917. It was, nevertheless, 
necessary in all cases to spend large sums of money in 
perfecting such arrangements, and in all the cantonments 
located in the Southern States to pay special attention to 
malaria. Around Camp Pike, near Little Rock, Arkan- 
sas, an area of about seventy miles had to be rendered 
mosquito free, although it is located approximately 200 



PREFACE 



XI 



feet above the river plane. This great care shows that 
otir experience in the Panama Zone has not been for- 
gotten, and that our army surgeons are fully aware of the 
danger lurking in malaria against the efficiency of an 

army. 

Whatever aspect of society we may consider, whether 
it be the arts of peaceful civilization, or the clashing 
arms of war, or the depressing problems of social in- 
efficiency or the future of the nation, we are always led 
back to health as a fundamental factor in social progress. 

Rudolph M. Binder. 

New York University, 
November, 1919. 



I i I 



PART I 

GENERAL RELATION OF HEALTH TO 

SOCIETY 



^'» . 



w 



CHAPTER I 



INTRODUCTION 

Health has been the greatest factor in the history of 
man, since it is the strong and healthy nations which 
have in the end conquered their richer and, perhaps, 
more civilized neighbors. For man had to contend not 
only with man in the struggle for existence, but with 
beasts and parasites. The battle against the beasts was 
decided long before the historic period, but that with 
man and parasites still continues. In his fight against 
disease germs man has frequently succtunbed. Whole 
tribes and even nations have been wiped out by the plague, 
cholera, and even less virulent diseases. And even to this 
day, in his battle with man, the parasites play an im- 
portant role, since the nation which knows how to control, 
or at least, change the activity of dangerous micro- 
organisms has an advantage of great importance* over its 
enemy. In times past, when no such knowledge existed, 
the nation which lived in regions comparatively free from 
parasites, was always able in the course of time to defeat 
its more numerous, richer, and more civilized enemy. 
History is hardly more than an endless repetition of 
victories by peoples coming from the north or the 
mountains — localities less infested with disease germs 
—over peoples living in rich and fertile plains, where 
these germs found more favorable conditions for breed- 
ing. 

From another point of view health has been of the 
Utmost importance,— that of civilization. Why have the 



4 HEALTH AND SOCIAL PROGRESS 

tropical and sub-tropical countries never attained to a 
permanent civilization? In almost every part of the 
world have civilizations sprung up around the latitudes 
of the Guicer and of the Capricorn, only to flourish for 
a short time, and perish when conditions were apparently 
propitious for a higher development. Reasons of vari- 
ous kinds have been assigned for this short life, — im- 
morality, luxury, infidelity, degeneracy, political oppres- 
sion, and almost everything else which the fertile imagina- 
tion of past and present day writers could conjure up. 
All these reasons undoubtedly had something to do 
with the ruin of ancient civilizations, but they operated 
only indirectly, and were themselves results rather than 
causes. It is only recently that medicine, with its study 
of tropical diseases, has revealed the true cause, — ill- 
health owing to the inability of former generations to 
combat disease-breeding parasites. For without physical 
health, no high and no permanent civilization is possible. 
If ill-health attends a people day after day, it lacks the 
ability to build up strong and vigorous bodies and large, 
sound brains. It is, consequently, compelled to reduce 
its activities to the absolutely necessary minimum, since 
a sick man does not act or think any more than he is 
compelled to in order to preserve life. No civilization 
can be built up, however, in that way. It requires great 
physical activity, and, above everything else, a clear 
and vigorous brain to invent schemes for freeing man 
from the thraldom of physical toil. For only in propor- 
tion as man succeeds in making nature do his work, is 
he able to attain leisure and to save time and energy for 
the development of art, science, philosophy, and litera- 
ture. Civilization has, consequently, a mental basis even 
in its material aspects of machinery and other labor- 
saving devices, and consists essentially in the ability to 



INTRODUCTION 5 

enjoy free mental activities along lines which give men 
pleasure, just because they are not needed for physical 
maintenance. These activities are, however, wholesome 
in proportion as the body is sound and vigorous, since 
out of the poorly nourished brain of a chronic dyspeptic 
or the disordered brain of a maniac all kinds of strange 
fancies proceed, which are neither sound nor sane. 
Physical health is, therefore, an essential element in the 
origination and maintenance of civilization. 

This fact has been almost entirely overlooked by his- 
torians, theologians, philosophers, and even some sociolo- 
gists. Human beings have been treated as if they were 
minds without bodies. Writings dealing with the history 
of man in its various aspects contain almost no references 
to health or disease except occasionally in very detailed 
biographies or when a war or an epidemic carried off 
thousands of people. This silence is, of course, due to 
the supposed independence of mental states from bodily 
conditions, survivals of which we have in the various 
forms of mental or faith healings of modem times, and 
in our attitude toward morality. 

Moralists and theologians require conformity and 
obedience to rules which are plainly intended only for 
well men. Kant's dicttun, " Thou canst, because thou 
must ! " is evidently teaching of this kind, because, by 
implication at least, the person who recognizes a duty 
is able to impose his will upon even a weak and diseased 
body, and make it do the work of one that is well and 
strong. This attitude has passed over into our legal 
codes, and we often punish a man by confinement in jail 
or prison, when we ought to send him to the hospital or 
to a colony for the feeble-minded. 

Health seems to be either assumed or to be ignored 
in the treatment of man. The Puritan considered a 



I 



6 HEALTH AND SOCIAL PROGRESS 

reference to his physical condition as sinful or at least 
indelicate, while most historians were either silent about 
the body or treated it with more or less open contempt 
Some writers openly expressed their views regarding the 
body as an obstacle to the mind's progress. " O wretched 
man that I am ! Who shall deliver me from this body of 
death?" says St. Paul (Romans 7:24). In Schiller's 
" Ideale und das Leben " the body is depicted as " sink- 
ing, sinking, sinking," as the mind— now freed from its 
heavy encumbrance— rises higher and higher. This neg- 
lect and contempt of the body goes back to ancient 
times, and it will be necessary to treat the attitude of 
past generations in regard to this problem at least 
briefly. 

It is certainly strange that such an important fact as 
physical health should not only have been neglected, but 
in many cases distinctly discouraged. Religion and 
philosophy have been the greatest sinners in this respect 
through their mistaken notion that the body was the seat 
of sin and hence an obstacle to the development of the 
spirit, while science has always taken a lively and sympa- 
thetic interest in fine, healthy physiques. 

Savages have, as a rule, paid more attention to the body 
than civilized peoples, because the exigencies of their 
condition always called for whatever physical strength, 
skill, prowess, and endurance they could muster; hence 
the great pains taken with the physical education of boys, 
and the care taken by the warrior of his health that he 
might either attain the chieftancy or retain it. Since 
efficiency was measured in warlike qualities, it was neces- 
sary that the body should be made chiefly an instrument 
for fighting; this involved, however, incidentally an all- 
round development and a certain amount of hygiene. 
The comparatively few children who survived the hard 



INTRODUCTION 7 

conditions of life were the most vigorous, and perpetuated 
their strength through their own offspring. 

The Hebrews are conspicuous from this point of view 
chiefly for their laws concerning physical cleanliness and 
purification — the effects of which are noticeable to this 
day, since a race has been created with strong physical 
tenacity and a high vitality, notwithstanding the confining 
life of the Ghetto. 

Among the Greeks, the Spartans stand out prominently 
in this respect, since they trained both men and women 
with the greatest care ; the former to be efficient warriors, 
the latter efficient mothers. 

The Athenians undertook physical training primarily 
for the sake of enjoyment ; it was a disgrace for a gentle- 
man to be sick, since he must be at least secondarily a 
good soldier. It may be said that health-culture was 
raised to the level of a fine art among the Greeks, which 
partook — as did all arts with them — of the nature of 
religion. They emphasized the element of health for the 
sake of proper enjoyment in conformity with the ideal 
of their gods, as the Hebrews insisted on cleanliness and 
purity in obedience to the ideal of Jehovah. 

Later Greek development was a decidedly retrograde 
movement. Platonism introduced the idea of the op- 
position of mind and matter — ^mind being conceived as 
the formative principle, matter as the chaotic and un- 
formed. This doctrine placed matter in a position of 
inferiority, since it hindered the development of mind. 
When this idea was added to the Hebrew conception of 
sin, and both were intensified by Christianity— the result 
showed itself in a deprecation of the body in every 
respect, especially since it came to be looked upon defi- 
nitely as the seat of sin and the obstacle to the free 
development of the spirit. It took but a short time to 



1 



8 HEALTH AND SOCIAL PROGRESS 

develop the " unwashed saints," Simon Stylites, and other 
exponents of perverted views of life. 

**• • • • • . I die here 
Today, and whole years long, a life of death. 
Bear witness, if I could have found a way— 
And heedfully I sifted all my thought- 
More slowly-painful to subdue this home 
Of sin, my flesh, which I despise and hate, 
I had not stinted practice, O my God I" 

Modem Christianity has not taken a definite attitude in 
this respect. Its advance agents exhibit a progressive 
tendency, chiefly for the sake of interesting young men 
and women. It may be said, however, that religion— 
whether Jewish, Christian or otherwise— can never ren- 
der the service it should render, unless it adopts the 
scientific view of matter as spiritual, and returns to the 
primitive Christian ideal of the body as " the temple of 
the Holy Ghost." This view is, moreover, decidedly in 
favor of viewing God as immanent rather than trans- 
cendent—a movement which is gaining a firm foothold in 
the churches owing to the influence of science. The neg- 
lect of the body and the conception of a transcendent 
kingdom of God have retarded a true civilizational move- 
ment considerably, since physical health, which is the 
only basis for mental wholesomeness, was deprecated, 
and the " other-worldliness " of the Kingdom kept men 
from exerting themselves to improve conditions in this 
world. 

Science, especially medicine as the science of health, 
has always favored a proper view of the body. Owing to 
the imperfect development of its auxiliapAtiences, e.g., 
chemistry, physiology, and bacteriolog^ffedicine was un- 
til recent times more or less hapraSard guesswork at 
curing diseases, but has now developed to a remarkable 



INTRODUCTION 9 

extent, and is gaining new knowledge almost daily con- 
cerning the nature of diseases. With this knowledge 
has come the conception of prevention as the true sphere 
of medicine, rather than mere cure. The prophylactic 
work of hygiene in its diflFerent aspects has produced 
remarkable results. Medicine has, moreover, joined 
hands with the engineer and the physical culturist in 
various successful attempts at sewage disposal, sanitation, 
ventilation, and a more systematic development of the 
body. 

Biology and psychology deal chiefly with life as it is 
actually found, but work indirectly for betterment of 
health, because only normal and healthy individuals in- 
sure, as a rule, progress. 

Sociology is concerned with the causes of the progress 
and decline of nations. It is par excellence the advocate 
of health—physical, psychical, political, social, and in- 
dustrial — since the efficiency of nations and races de- 
pends on the maintenance of health. 

Eugenics, finally, is a new branch of biology and soci- 
ology, and attempts to solve the problem of racial health 
by proper mating of the physically and mentally fit, and 
by the elimination, of the unfit through prohibition of 
mating. 

These various eflForts have produced many important 
results in lessening the amount of sickness, improving 
health, and chiefly in changing our whole attitude toward 
the body as the instrument of the mind. 

In no period of history was health considered of such 
great importance as it is in our own times. In practically 
every sphere of life, people take the greatest interest in 
their physical and mental well-being. Individuals, 
schools, voluntary associations of various kinds, even 

fovcmmcnti btve takta up thii quMtion with % Kit 



10 



HEALTH AND SOCIAL PROGRESS 



INTRODUCTION 



11 



!! 



that augurs well for the future. The number of books 
which have been written on this topic, is literally more 
than the proverbial legion. From the platform, in lec- 
tures and pamphlets, in newspaper and magazine articles, 
we are told how to keep well. The ntunerous health- 
resorts, sanatoria, and similar institutions which promise 
to build up broken-down constitutions are filled to their 
utmost capacity and new ones are established every year. 

What is the reason for this great interest in health? 
Are we more ill than our ancestors, or are there special 
causes in our times, which demand greater consideration 
of health? 

Whether we are in better health than our ancestors is 
a much debated question among sociologists and need not 
be entered into here. Data will be given in a later chapter 
(see page 28) to answer the question in the affirmative. 
The reasons, however, for our great interest in health arc 
plain, and they may be divided into social and scientific 

Whatever the ultimate relation of mind and body may 
be, no person denies the tremendous importance of a 
sound body as an instrument of the mind, especially in 
relation to social life in its various aspects. Our indus- 
trial life has created conditions which make a close inter- 
dependence of one man upon another an absolute neces- 
sity. Formerly when a man was ill, his work could wait 
until he was well, and no one else was inconvenienced ; but 
. if an employee in a factory is unable to perform his duty, 
hundreds if not thousands of other employees have to 
stop work owing to the dependence of one operation upon 
every other. The financial loss is, of course, too great to 
do that, and the sick employee must be replaced by an- 
other. Again, if a farmer while driving to town gets 
dizzy and falls from the wagon, his horses may run 
away and he may break his neck, but the dsimage is con* 



fined to himself and family. If a locomotive engineer 
suffers from a similar affliction and runs his train at full 
speed into an open switch, hundreds of people may be 
killed or maimed for life. These are but two out of 
many cases in which modem conditions differ funda- 
mentally from those of former days or from those in our 
own times where a man still works singly. Hence the 
importance of health in modem industry. 

Briefly stated, health in relation to modem conditions 
may be viewed from five aspects: (1) The proper per- 
formance of one's work and duty is impossible without 
at least fair health. A man may force himself, but in that 
case his work will be done poorly, or the wear and tear 
on the constitution will be so enormous as to bring about 
a considerable weakening, thus predisposing the worker 
to disease, or at least lowering the power of resistance. 
(2) Apart from the mere performance of work is that 
of exactness and accuracy. A man enjoying good health 
is less apt to make mistakes than one who is below 
normal. That means an immense saving in time,. money, 
friction, mental wear and tear to himself and to the 
establishment, since such work needs less supervision and 
scarcely ever a doing-over. (3) Ease and cheerfulness at 
work is another important aspect. There is a tremendous 
difference between a worker whose body is ready to per- 
form, craving an outlet for its abundance of energy, and 
one whose body protests almost at every step taken, and 
still more against the continuous exertion during work. 
The former will work with ease, sing and joke; the latter 
will watch the hand of the clock and sigh with relief when 
It strikes six. (4) When the two leave the shop, the dif- 
ference between them still continues in their recreation. 
The present tendency is everywhere for shorter hours so 
as to give the worker more leisure. But what can a man 



12 HEALTH AND SOCIAL PROGRESS 

do with his leisure when he is so tired out that he is 
scarcely able to drag himself up the steps of his house. 
He IS unable to use it for reading or social intercourse ; 
the chances are that he will seek a stimulant to create an 
artificial cheerfulness. The other man has at least the 
opportunity to improve his mind by reading, going to a 
lecture, or through social intercourse. (5) The purely 
social value of good health is, perhaps, more important 
than any other. Exuberant spirits and robust health are 
distinct social assets. We all feel instinctively drawn 
toward a cheerful, pleasant-spoken person; his very 
presence is a blessing, his smile contagious, and he is 
welcome wherever he goes. The father returning from 
work with a cheerful smile and a pleasant word for 
wife and children, is anxiously looked for, because he 
spreads sunshine in the house. The man who is wearied 
through work, owing to low vitality, is inclined to find 
fault with everyone and everything, and is shunned, be- 
cause he spreads gloom by his very presence. From a 
dramatic and literary point of view " Rebecca of Sunny- 
brook Farm " may be inferior, but from the social point 
it is a distinct asset, because it proves the value of good 
health and a cheerful disposition. 

The scientific reasons for fostering health are some- 
what more remote, but none the less real. The rapid 
expansion of the natural sciences, especially of biology, 
during the nineteenth century, contributed many elements 
toward a change in our attitude toward the body, since 
the doctrine of evolution depends primarily on the good 
health of the various species. The survival of the 
fittest meant in the animal realm and for a long time in 
human history, the survival of the physically fit, because 
only the organism endowed with strength, fleetncss, or 
oAer phyiical charactcriitia iniuring lupcriority had a 



INTRODUCTION 13 

chance to survive and propagate. These qualities are, 
however, reducible to health, since without that they 
could not be developed; nor are they, if developed, of 
much use without it, since the swiftest wing or foot, the 
strongest jaw or claw would be incapacitated by disease. 
An animal might react promptly and efficiently hundreds 
of times in escaping its enemies, but the parasites in its 
own system it could never escape. Hence there is no 
natural death among the majority of animal species, be- 
cause when the bacteria have lowered vitality, even the 
swiftest and the strongest fall a prey to their enemies. 

The interest in biology led in its turn to the various 
attempts to explain man's nature on the basis of his 
environment, and as a result of this new view of life. 
Buckle wrote his History of the Civilisation of England, 
and Ratzel his Anthropo-Geographie. " Man can no more 
be scientifically studied apart from the ground which he 
tills, or the lands over which he travels, or the seas over 
which he trades, than the polar bear or the desert cactus 
can be understood apart from its habitat. Man's rela- 
tions to his environment are infinitely more numerous 
and complex than those of the most highly organized 
plant or animal. So complex are they, that they con- 
stitute a legitimate and necessary object of special study. 
Ihe investigation which they receive in anthropology, 
ethnology, sociology, and history is piecemeal and partial, 
limited as to race, cultural development, epoch, country 
or variety of geographic conditions taken into account.' 
Hence all these sciences, together with history, so far as 
ftistory undertakes to explain the causes of events, fail 
to reach a satisfactory solution of their problems largely 
^cause the geographic factor which enters into them all 
^ not been thoroughly analyzed. Man has been so noisy 
aoout the way he has conquered nature, and nature has 



* 



14 HEALTH AND SOCIAL PROGRESS 

been so sflent in her persistent influence over man, that 
the geographic factor in the human equation has been 
overlooked." * 

These studies led to an investigation of the disappear- 
ance of nature-peoples, and it was found that their decay 
and extinction was due not so much to the cruelty of the 
" white man," as to various endemic diseases, some of 
which had existed among them for many generations and 
became more virulent under new conditions of life, while 
others were introduced by civilized man on his advent in 
new countries. It is no exaggeration to say that the fate 
of many nations and innumerable tribes has depended on 
various diseases; and chiefly the endemic, because epi- 
demics caused as a rule great mortality, and thus by 
attracting attention, produced measures to combat them, 
while endemics worked insidiously and more injuriously, 
leaving the people in ignorance of their danger. The 
Greeks and the Romans, for instance, were never aware 
of the danger which threatened them through malaria, 
and took no measures to counteract its ravages. The 
study of the disappearance of nature-peoples through 
disease created a new interest in health among civilized 
peoples, especially among physicians who had worked In 
tropical countries. 



1 



J 



CHAPTER II 



MEANING OF HEALTH 



What is health? In defining or even describing health 
much depends on the point of view. The average man 
considers himself healthy when he is not ill, and many a 
person who is suffering from an endemic disease, e.g., 
malaria or hookworm, considers himself well, just be- 
cause he is not seriously sick. The physiologist would 
consider health as a normal functioning of the cell, be- 
cause he takes that as the unit of his investigation. The 
sociologist, on the other hand, looks upon the body from 
the point of view of action, and he must describe health 
in terms of the whole man as he reacts upon the various 
stimuli which come either from within or from without. 
These reactions are, however, ultimately mediated in the 
brain or in the mind, and they will be the more perfect 
and economical, the less friction there is in the physical 
organism. Hence we may say that a person is healthy 
when he is, except incidentally, unconscious of his body. 
The definition may seem strange at first sight, but it im- 
plies all the elements which enter into a full description 
of health. It means the state of body which enables it 
to perform every function which can reasonably be ex- 
pected of it, to accommodate itself to each ordinary task, 
and to be equal to some exertion without painful sense of 
fatigue. This implies as external signs erectness and 
firmness ; as internal requisites, good construction, ability 
to adapt itself to widely divergent conditions of life or of 
climate without deterioration of energy; endurance, re- 

15 



16 HEALTH AND SOCIAL PROGRESS 

sistance to morbific influences ; and finally, it means self- 
control — mental, emotional, and sexual ; briefly, a balance 
between organs and organism, so as to produce a coordi- 
nated whole, well equipped for action. 

This description does not refer to robust health, but 
merely to a person who is well. It may be illustrated 
briefly as follows : The healthy man wakes in the morn- 
ing without any recollection of what happened since he 
went to bed, since he has had a continuous, unbroken, re- 
freshing sleep. He is ready to get up and has no desire 
to linger in bed; his toilet is performed without delay, 
for he is hungry, and has visions of breakfast. When this 
is over, he proceeds to the business of the day at once, 
whatever that may be, since he loves his work. This he 
does with all diligence and dispatch, because his body 
answers to the summons of the mind with ease and 
accuracy. Hence he will not be exhausted when the 
day's work is done, but will have some energy left over 
for exercise, friendly intercourse, or mental improvement. 
Then he goes to bed, and is soon asleep. This man has 
scarcely been conscious of his body either by night or by 
day except incidentally when washing, dressing, and eat- 
ing. If he had any sensations at all about it, they were 
pleasant, at least mildly so, since the sense of organic 
well-being is one of diffused pleasure. He enjoys his 
meals, but never has to care what becomes of the food 
afterward, since his digestive organs perform their work 
automatically ; he may perhaps remember his meals again 
through an increase of strength and well-being. 

Perhaps the best thing about good health is the fact 
that work does not weary us, but helps to develop our 
various faculties. Hence the day's work always leaves 
us in better condition than it found us; it has opened 
new possibilities before us, has given us opportunities 



MEANING OF HEALTH 



17 



for exercising our various powers and for spending our 
surplus energy. The healthy man is able to make every 
movement graceful, effective, and adaptive; and the 
profit from the day's experience will enable him to do 
tomorrow's work better. He re-creates himself con- 
stantly. 

It is not necessary to point out that good health is not 
identical with athletic strength or endurance. The tasks 
of life differ, and each task requires a slightly different 
physique, as Aristotle observed in his Politics (Book I, 
Chapter VI). The health and strength of a hod-carrier 
must be different from that of a professional man ; the 
former needs a well-developed muscular system, the latter 
an especially fine brain and nervous system. If each is 
able to perform his particular work well and without 
exhaustion, he fulfills his destiny, and renders not 
only a social service but gets profit and pleasure from 
it. 

Health may be identified with good vitality, or surplus 
energy. Good vitality means simply a reserve fund be- 
yond what is immediately needed. The greater this re- 
serve, the better prepared is the organism to meet all 
kinds of exigencies with ease, and to stand shocks with- 
out serious injury. 

"Two men undergo operations of the same character in a 
hospital. The same surgeon does the work. The conditions 
are identical. Equal care is exercised in each operation, and 
each is successfully performed. Yet one man recovers, the other 
dies. 

'There is a tremendous business pressure which does not 
let up for months. It puts men under terrible strain. One man 
goes to pieces and his business is wrecked. He cannot keep 
the pace; he loses control of himself. His rival has no better 
brains than he-i)erhaps not so good— yet he pulls through suc- 
cessfully. 



m 



4ii 




18 HEALTH AND SOCIAL PROGRESS 

" We say that there is a difference in vitality ; that one man 
has more of it than the other. 

"I once saw a man in a hospital who was suffering from 
five fatal diseases ; and yet he would not die. He kept on living 

^^"«r / r*' '" 'P^*^ °^ everything. He refused to succumb. 
We find the same thing illustrated every day. In a ship- 
wreck there are many who seem to give up their lives without 
a struggle, without any power to resist. Others cling to an 
open raft for days without food, almost frozen, constantly 
whipped by the waves, but for some reason they survive. The 
vitality in them is strong. 

"Notice how rapidly and surely one man recovers himself 
after a nervous breakdown, while another drags along through 
years of semi-invalidism. Notice the results upon two men of 
a long, cold drench of rain. One of them comes down with 
pneumonia; the other suffers no iU effects. How is it to be 
explained ? 

" He has a reserve somewhere, an inner power of resistance, 
an aggressive something that will not be downed— and we call 
It vitality. A man cannot have a more valuable asset than that 
It means joy instead of dumps, success instead of failure, life 
perhaps, instead of death." a * 

No one will contend that under the circumstances just 
quoted, a healthy man is unconscious of his body; but 
these men were sick for the time being, and their cases 
are cited merely to show that men who enjoy good health 
store up surplus energy or vitality which stands them in 
good stead in an emergency. At such times there is still 
a vast difference between the man in good health and the 
one in poor condition. When special stress is to be 
borne calling for great exertion, the man in poor con- 
dition will dread the necessity, become apprehensive, and 
thus spend his energy ineffectively; while the well man 
will look forward with confidence to the trial of strength 
and react efficiently. He is able to do this because when 
he becomes clearly conscious of his body, he is aware 
of his strength and power; his whole organism seeks 



MEANING OF HEALTH 



19 



relief from the tension of stored-up energy; while the 
other, always more or less conscious of its existence, 
now becomes more than ever aware of its weakness and 
slender resources. Under normal conditions the well 
man is, however, as a rule unconscious of his body, unless 
it be an awareness of diffused organic well-being. 

This fact may be illustrated in other ways. A healthy 
child who laughs and runs and romps, acts spontaneously, 
not deliberately. When he has to be urged and coaxed 
to do these things, he is not well ; he is conscious of an 
effort, he must exert himself, and the more he does so, 
the more conscious he becomes of his weakness. A young 
dog who for no reason whatever will run up and down 
the avenue as fast as he possibly can is unconscious of 
his body. Only after he has spent his surplus energy 
and needs rest and food is he aware of his legs and 
stomach. 

Health means, then, spontaneity and freedom of action. 
" It is as * the outward sign of freedom, the realization 
of the universal will ' that health may be set at once as 
sign and goal of the harmonious operation of the whole 
system — ^as sign and goal of the realization of life." • 

A healthy man is able to turn his energy in any direc- 
tion desired, because his body responds promptly and 
efficiently ; its energy is always ready to be expended. It 
is usually the man in poor health who has to " make up 
his mind " ; the one in good health is able to decide 
quickly, because with a clear brain and efficient nervous 
system he can instantly " feel the situation," devise a plan 
immediately, and say " yes " or " no." The other man 
must in reality get his body ready; he has too little 
energy to meet the new situation at once, and asks for 
delay in order to " think it over " when he is not other- 
wise occupied. To conclude, then, health m^ans freedom 



20 HEALTH AND SOCIAL PROGRESS 

of action because it implies being unconscious of the body 
— owing to surplus energy. 

This principle may be proved by a reference to the 
meaning of disease. In health all life-functions proceed 
without any friction and self-assertion on the part of the 
organs, hence the individual is normally unaware of his 
body. But let some organ get out of order, and we soon 
become aware of its existence. The very fact that pain 
is a danger signal implies that generally the operations of 
a well-ordered body proceed smoothly and unconsciously. 
Pain means, therefore, that a particular part of the 
organism is unable to carry on its work unconsciously; 
while usually so contented to serve the organism in ob- 
scurity and oblivion, it asserts itself vigorously the mo- 
ment it can no longer do so, and notice is given to the 
whole body through the nervous system that help is 
needed. For pain is merely the cry of nerves that are 
either starved, poisoned, or throttled. And the finer the 
organism is constructed, and the more delicately balanced 
the various parts are, the better is the signal service of 
danger organized. Hence the higher species of animals 
and the more finely grained human beings are more sus- 
ceptible to the slightest disturbances. The ox-cart of a 
Montenegro peasant will render fair service after many 
parts are out of repair and some even broken; but the 
automobile of fine construction will " go out of commis- 
sion " the moment one small screw is loose or lost. So 
the savage will bear a fracture of an arm or even a 
slight one of the skull with comparative equanimity after 
the first shock; he usually recovers quickly without 
medical attendance: the finely grained European may 
suffer intensely and take considerable time for recovery ; 
he cannot even witness pain in other men or animals with- 
out sympathy, or suflFering with the other. Homer un- 



MEANING OF HEALTH 



21 



consciously intimated that the Greeks were more highly 
civilized than the Trojans when he said that the former 
felt pain more keenly as witnessed by their outcries, while 
the latter were mute even when wounded severely. The 
same principle applies to Mars, of whom we are told that 
he roared with pain when struck by the spear of Dio- 
medes, for as a divine being his nervous system would 
naturally be more highly organized.* 

In the anxiety to avoid injury, i,e., to disturb the 
balance between the various parts, nature has devised 
innumerable schemes through division of labor in order 
to scent danger before it actually reaches us. This princi- 
ple is most ingeniously elaborated in the case of the 
curious antennae, or feelers, which are thrust out from 
the surface of the body in animals of all sorts, especially 
in insects. Its most striking development is the well- 
known whiskers of the cat, and the less familiar, but 
much more highly developed, tactile hairs about the head 
of the bat. These feelers extend from half an inch to an 
inch from the body in order to warn it of approaching 
danger through the sense of touch. In more highly 
organized animals the senses of sight, hearing, and smell 
are, in part at least, intended to be guards against danger, 
extending their sphere over much larger areas. The 
reason for this extraordinary sensitiveness to pain and 
these precautions against danger is the extreme care 
which the organism takes in preserving its integrity or 
wholeness. For if the danger signal is to be of any 
value, it must be accurate so as to report the slightest de- 
viation from the normal, and must be placed as far in 



^uV^^J'^^^.^' "Bellowed brazen-throated Mars, loud as nine 
Tro^fn. warriors, or as ten joined in close combat. Grecians, 
irojans, shook, appalled alike at the tremendous voice of Mars 
msatiaWe with deeds of Wood/' ' 



72 HEALTH AND SOCIAL PROGRESS 

the foreground of the battle as possible so as to give time 
for measures of avoidance. 

Accuracy in interpreting danger signals is, however, 
possible only in good health, whether the danger is from 
within or from without. An organ which is in poor con- 
dition asserts itself so peremptorily and constantly, that 
other organs may be neglected or are made to suffer, and 
thus become unable to do their work properly. The nose 
is a useful organ and performs valuable services to the 
organism all more or less unconsciously to ourselves; 
for while it is in a sound condition we act promptly on 
the information it gives us, and are hardly aware of its 
existence for weeks at a time. A cold in the head very 
quickly changes this relation. Our sense of smell suflFers 
almost instantly and we are less able to judge accurately 
of the information received from that quarter. But that 
is not all. This organ asserts itself so vigorously at 
such a time that we are but little able to do anything else 
than attend to it. Neighboring organs are likewise af- 
fected, e.g., the eye, which becomes watery, and the ear, 
which becomes less acute and discriminating — we hear 
noises rather than distinct sounds, and fewer of them. 
The three main sentinels against external danger are 
thus invalidated. And what happens to the organism? 
It is more or less out of working order, less aggressive, 
less capable, perhaps incapacitated. Why? Because the 
nose asserts itself so vigorously that most of the energy 
produced by the organism is drawn into service for re- 
pairing the breach made in its wholeness. For the sys- 
tem must be whole if it is to function properly in the 
various exigencies of life. If a more important organ 
is hurt, we call ourselves sick and go to bed, so as to 
give the organism an opportunity to attend to its repair 
work exclusively for at least some time, 



MEANING OF HEALTH 23 

Health means, moreover, economy of expenditure. 
While there is much friction in the organism during sick- 
ness in performing even the most elementary work, there 
is hardly any during health. We simply go ahead, un- 
mindful of our body. It is a ready instrument of the 
mind, and we realize its existence only at night when 
tired out. That feeling of lassitude is simply a signal to 
stop and rest. It is not an unpleasant, but rather an 
agreeable feeling to relax and go to sleep. A few hours 
of rest are sufficient to restore our energy, and we wake 
up automatically, ready to go to work again. Compara- 
tively little food is needed to keep a healthy person in 
good condition, because no repair work is needed and the 
power of assimilating all nutrient elements is strong. A 
physician said a few years ago concerning a patient who 
suflFered from consumption of the throat, that her food 
had sufficient nutrient values to keep seven ditch-diggers 
in good health. Still, that young woman cbuld hardly 
move in bed without severe pain. We are surprised 
when we read of the black bread, a piece of cheese, and 
the small amount of sour wine, which keep many Euro- 
pean peasants not only in good health, but literally in good 
working condition. There is no secret about it, though ; 
the system does not waste anything, and new energy is 
quickly supplied by simple food and sleep. The China- 
man with his handful of half-cooked rice is even a 
better example. He works hard and continuously on 
this scanty food, and seems to be untiring. Such energy 
can be explained only on the basis of good assimilative 
power and high vitality, as seems to be indicated also by 
his resistence to high fevers and by his bluntness of 
nerve which enable him to recover rapidly from terrible 
injuries. 

This economy of expenditure has a very important 



m 



24 HEALTH AND SOCIAL PROGRESS 

effect upon the development of the higher faculties. When 
there is little or no friction in the organism and assimi- 
lative powers are good and work is not too exhausting, a 
surplus of energy is easily produced. This energy can 
be used for experimentation along various lines, either 
through play or through more serious attempts at inven- 
tion in abstract thinking, imagination, and actual recom- 
bination of mechanical contrivances. There is no need 
to discuss the theory of play here ; ♦ suffice it to say that 
a certain amount of unused energy must exist in the 
organism if play is to be indulged in. No doubt instinct 
directs play along certain lines, and nature selects only 
animals which play efficiently and which thus prepare 
themselves better for the more serious duties of adult 
life — but no animal or human being will play when fully 
exhausted. He may fight his teasing friends with his last 
ounce of strength for the right to rest or sleep, but he will 
not play. He may change his occupation from reading 
to walking, and thus rest his tired eyes and brain while 
exercising his unused legs, but when he is tired all over, 
he will rest if he possibly can. If he attempts to force 
himself, the result is as a rule pitiful. We are familiar 
with the official smile and joke at the President's re- 
ception—and elsewhere— with its mirthless laugh and 
forced friendliness. It deceives only the gushing girl 
who cannot distinguish between spontaneous humor as 
the result of abundant vitality and the make-believe in- 
terest of a tired man who wants and ought to be in bed. 
This surplus energy enables those who direct it properly 
to develop both mentally and physically, and leads thus 
to an enrichment of life with the possibility of arriving 
at new and possibly useful variations. The theory of 
the leisure class in social science is based on such a 
surplus. It is, however, not so much a greater supply 



MEANING OF HEALTH 



25 



of goods than is needed for the maintenance of life, as 
it is a greater amount of vitality for the ordinary duties 
of life, that is of real importance. It is, in other words, 
not so much a question of wealth as the economists and 
sociologists would maintain, as it is a question of health. 
This may be proved briefly in two ways. A rich patient 
confined to bed more or less all his life consumes, but 
rarely creates wealth, while a poor man with surplus 
energy will study, write, experiment, and produce some- 
thing beneficial for society. Again, the fact that many 
inventors have come from the better class mechanics and 
that many discoveries have been made by teachers in col- 
leges and universities is explained better on the theory of 
health than on that of wealth. For after all, there is 
nothing that interests the man of low vitality except his 
own condition, and he could not as a rule make use of 
extant knowledge as a basis for extending it, even if he 
would. Why not? Because such men do not develop 
any surplus energy. A brief consideration will make 
this dear. 

We have seen that even a less serious defect in one or 
another organ causes the whole organism to divert its 
energy toward the ailing part and interferes thus with 
its general functions of being a good working machine 
for the mind. To give one more illustration. Adenoids 
are not a serious defect in themselves. Yet this slight 
derangement of normal breathing may have serious ef- 
fects upon the mentality of a child, because it diverts 
the functions of the body from their usual and mutually 
helpful character to a particular organ in order to remove 
the obstruction. The organism becomes thus self-cen- 
tered, so to say, instead of being an unconscious agent 
of the mind. That means that no surplus energy can be 
developed while the obstruction lasts, since whatever 




26 HEALTH AND SOCIAL PROGRESS 

energy is developed goes first of all into the main- 
tenance of the vegetative functions, and secondly into 
the removal of the obstruction. The body as a whole 
is thus not properly nourished. This explains on the 
one hand the proverbial fertility of the poorly nourished 
part of the population, since nature is bent on the con- 
tinuation of life at all costs and every ounce of surplus 
energy is turned into reproductive activities ; on the other, 
the many cures which the organism effects without medi- 
cal aid, since it must work with the least friction possible 
and as a whole, if it is to work well. But some parts 
must suffer from this under-nutrition. The nervous sys- 
tem and the brain are the ones which do not receive 
proper nourishment under these conditions. They are 
kept at the lowest minimum possible for regulating the 
organism ; but they cannot be alert, accurate, and aggres- 
sive: neither can they be finely wrought and sensitive. 
The associative centers or the cortex suffer most from 
this lack of proper nutrition, hence they cannot exercise 
the necessary control over the body, and the latter acts in 
an erratic manner; that is, without properly valuing its 
actions in proportion to their importance to the organism 
as a whole. Lack of unity of action is the result, and 
mentality remains at a comparatively low level. It is 
evident that a person in that condition is unable even to 
organize new information received, or much less to 
originate anything new by recombining the elements of 
knowledge already in his possession. 

It is different with people in good health. Just because 
they are well nourished, the brain has at least an oppor- 
tunity to be kept in proper condition owing to the surplus 
energy of the organism. Whether an individual will use 
that energy for building up his brain or his muscle, is, of 
course, a different question. He may prefer to exercise 



MEANING OF HEALTH 



27 



his muscles and build up an athletic body, or to use his 
brain more and perfect its functions. Whichever he 
does, the law of the growth of the most used part holds, 
and that part will develop correspondingly in power. If 
it is the brain he exercises most, its ability to form new 
adaptations and combinations quickly and accurately will 
increase, and the individual may contribute something 
new to society. The question whether there is an in- 
crease in the mass of the brain through exercise is not 
yet definitely settled ; the increase in power by means of 
more numerous and better organized association-paths 
is, however, undisputed. It seems a natural inference 
that a higher brain power draws more nutrition from the 
body as a whole. Whether that is true, is still unsettled ; 
experience seems to point that way, since people with 
massive brains— finely organized and capable of much 
hard work— rarely belong to the high vitality class, but 
usually to the medium, according to Professor Giddings.* 
The body of the great thinker is, in other words, organ- 
ized for action along a particular line— that of mental 
exertion in poetry, art, philosophy, science, statesmanship, 
administration, or similar vocations where facts have to 
be seen from a new angle or to be classified under new 
generalizations. 

We have thus far considered chiefly the lack of proper 
power of action of the organism due to more or less 
serious illness or defect. In each case the body was 
deficient through the self-assertion of some organ. Mal- 
nutrition has the same effect, but more continuously. 
The body in that case is unable to supply the various 
parts, particularly the brain, with proper power, and 
hence the whole organism suffers from inability to act 
properly and efficiently. And just as the sick man be- 
comes self-centered, so does the man of low vitality. 



>1k 



['Ml 



28 HEALTH AND SOCIAL PROGRESS 

He is continually conscious of his inability to adapt him- 
self to new conditions and is reminded of his failures. 
His mental attitude is self-centered ; he looks inward, not 
outward ; he is always concerned with himself, and must 
of necessity be so, as long as his body is an inapt agent of 
the mind. A healthy man is as a rule a social man ; a 
sick one is usually unsocial. If a well man is self- 
centered, he is so deliberately ; but one in poor health is so 
by necessity, since he is always conscious of the limita- 
tions of his body. 

Sickness or malnutrition may, however, happen to a 
whole race. Many savage tribes and many poor classes 
among civilized nations suffer from the latter defect and 
are unable to rise to a higher mental life because of 
poorly nourished brains, or to a higher social level owing 
to the inherent social limitations of men of low vitality. 
The larger part of mankind has, however, suffered from 
diseases of various kinds. If these were malignant or 
epidemic, men died, and only the strongest remained. If 
they were benign and endemic, a gradual deterioration 
took place, since just as in a serious illness the energy 
of the organism is diverted from its proper uses to the 
repairing of "broken down ramparts," so in endemic 
diseases there is a constant endeavor merely to ward off 
danger and to build fortifications against invading ene- 
mies. Among nature-peoples malnutrition and endemic 
diseases often combine, and the organism is unable to 
resist the double strain. Hence hundreds of tribes have 
succumbed, and only a few have survived. These were 
generally so exhausted from the struggle that their power 
of resistance was very small, and any new disease that 
might be introduced would kill them. Whether as in- 
dividuals or as a race, people with low vitality have poorly 
nourished brains, small power of adaptation and any new 



MEANING OF HEALTH 



29 



strain or exigency will upset them completely; hence 
they either perish or spend proportionately so much 
energy, that a more serious exhaustion results, and this 
prepares the way for a further loss of power of re- 
sistance, since there is no way to create surplus energy. 
Whether in the case of the individual or in that of a 
race, low vitality produces an attitude which centers 
in the individual rather than in society. 

High vitality produces, as a rule, social action. " The 
natural glowing fire of health— superb health— is seen and 
felt. It is magnetic. It makes for itself place and fol- 
lowing. It is constructive. It is initiative. It is happy. 
It is humane. It is beautiful. It radiates strength and 
brightness. It agitates for the good of others. It com- 
pels pleasantly to be and do one's best." « There is an 
expansive quality about good health which we realize only 

when in the presence of a man abounding in vitality 

good-natured and buoyant. Such a man is always master 
of himself, because he is unconscious of his body. Not 
having any ills of his own, he is happy, and his happiness 
is contagious, because it is spontaneous. He not only 
radiates peace and contentment, but wants to see others 
happy and cheerful. Being always master of himself, 
he is tactful and spares the feelings of others. If he has 
the gift of humor — as he usually does— it is good-natured 
and not sarcastic or sardonic like that of the dyspeptic 
who trusts nobody because he is not sure of his own 
power. The healthy man wants a well-ordered environ- 
ment, since his own mind and body make a harmonious 
whole. He generally succeeds, too. For he who is 
master of himself is best able to bring order out of chaos 
among those around him. He has few, or no, troubles of 
his own, and his abounding energy seeks an outlet in 
helping others. His whole activity is directed outward 



30 



HEALTH AND SOCIAL PROGRESS 



MEANING OF HEALTH 



31 



>« ) 



m 



toward conquering difficulties which he attacks with zest 
and vigor because they furnish good practice for his 
various powers. He is, in other words, not merely moral, 
but social, for sociality rises above morality. 

** Objectively viewed, morality consists of that ' walk and 
conversation ' which the community as a whole approves. It 
includes not only acts, well adapted to the achieving of those 
ends that on the whole are held to be good, but also outward 
expressions of thought and feeling, so far as these are ap- 
proved. Subjectively, morality is self-respect, and that desire 
for the good opinion of others, and that endeavor to deserve 
it, which Mr. Spencer has called ego-altruism. . . . 

" As the name itself implies, sociality comprises those quah- 
ties of mind and character, of disposition and conduct, which 
are eminently and characteristically social. 

" Objectively viewed, sociality is a cheerful and efficient par 
ticipation in the normal comradeship and cooperation of society. 

** Subjectively viewed, sociality is altruism — thought fulness for 
others, sympathy with others, kindliness and helpfulness toward 
others, even at some cost of self -sacrifice, and happiness in the 
companionship of one's kind." ^ 

A person with low vitality may be moral ; by precept 
and training he may be able to overcome the tendencies 
toward self-centering activities to which he is naturally 
inclined ; but it takes a positive, and sometimes a strong, 
effort to do so. This fact is well and frequently illus- 
trated by numerous people who, cursed with a low vital- 
ity, sometimes make herculean efforts to reform, only to 
backslide after many failures. They may be charged with 
moral delinquency or even depravity; but the blame for 
their failures should be laid at the door of low bodily 
vigor or some physical defect. Where vitality is some- 
what higher, we still have only a limited morality. A 
rich person may refrain from definitely unsocial or im- 
moral acts ; he may even give from the abundance of his 



possessions to poorer people out of self-respect or to 
maintain the good opinion of others ; but he cannot give 
cheer, hope, buoyancy, and efficient service, because he 
needs whatever strength he has for himself. The sour- 
faced man may solemnly declare in a prayer meeting that 
he loves his f ellowman with his whole soul, but the fulfill- 
ment of his promise is not in his power, since in his case 
the spirit may be willing but the flesh is literally weak; 
and no man can give what he does not have. It is the 
same way in larger matters. A person of low vitality 
may be willing to lay down his life for his country; he 
will not go far before he is in need of Red Cross nurses. 
The Athenian of the times of Philip of Macedon avowed 
his patriotism in the strongest possible terms, but Demos- 
thenes informs us that Athens talked about hiring 10,000 
or 20,000 soldiers ; for this malaria-ridden Athenian could 
not take the field like his ancestor of the previous century. 
He was not a hypocrite in protesting his love for Athens, 
while preferring to stay at home; he simply could not 
take the field owing to low vitality. Lack of health al- 
ways confines one's good intentions within narrow limits. 



■ 



. HEALTH AND RELIGION 



33 



!i."t 



CHAPTER III 

HEALTH AND REUGION 

Whether the origin of religion is to be attributed to fear 
as with Lucretius, to a feeling of dependence as with 
Schleiermacher, to the dread of ghosts as with Spencer, to 
awe before the Great Dreadful as with Giddings, or to 
other less definite qualities of modern theorists, there is 
ultimately just one thing back of them all — an attitude of 
helplessness on the part of man to do what is necessary 
or desirable. This goes back to low vitality, if not to 
poor health. A man may be ignorant and not trouble 
himself about the explanation of things. But if he is 
well, he will be able to satisfy the few wants which primi- 
tive man feels. Fear is apt to grip the weak man who is 
left behind and is unable to provide for himself, but not 
the hunter or the warrior who delights in action. It was 
the " squaw man," roughly speaking, who had time, and, 
maybe, good reason to begin crude speculations on how 
to escape his often intolerable position, and who has 
expressed his attitude in all the earlier or negative re- 
ligions. 

The limitations imposed by poor health have been the 
cause of our slow advance in civilization. We have 
progressed only in a self -centered manner. Our religious 
and our moral codes are all self -centered, and could not be 
otherwise under past and present conditions. In the past 
man has always sought merely relief from evil. This 
has given our morality an almost purely negative char- 
acter, and to our civilization one of pessimism. For 

32 



civilization was dominated by religion, and we have not 
yet fully escaped from its negative ideal. 

What, then, is the ideal of religion ? Relief ! Which- 
ever way we turn, the various forms of religion always 
have to do with that. It is either relief from physical 
dangers, or from spiritual enemies, or from ourselves, 
that is sought. Whether we are told that sickness is a 
visitation from God, or that evil power may tempt us, 
or that individuality itself is evil and that we must seek 
coalescence with the infinite in Nirvana, it is always re- 
lief that is held up before us, i.e., a purely negative ideal 
— ^an ideal in other words, which was conceived by and 
intended for sick people, or at least those of low vitality. 
Such an ideal is essentially self-centered. The religious 
man whose chief concern is to save himself, is still acting 
only morally and not socially, for he is occupied princi- 
pally with himself. This fact is strikingly illustrated in 
the various monastic ideals which plainly inculcate as the 
first duty salvation of oneself — expressed, however, in 
the more euphemistic terms of love and service toward 
God. The Golden Rule, whether in the negative form of 
Confucianism or in the positive of Christianity, is a 
self-centered principle, since action is based on self- 
regard, one might ahnost say, of personal advantage. 
The chief virtue of Christianity is charity — relief from 
distress; and its principal form is almsgiving — "laying 
up treasures for yourself in heaven." 

Is, then, the religious or charitable man selfish ? Not at 
all. He has a finely organized nervous system for feeling 
pain and suffering, and is therefore often more sympa- 
thetic in the literal sense than well people sometimes are. 
This is significantly expressed by the fact that the older 
form of charity almost confined itself to the relief of 
pain and suffering. That gives it a certain social value 



m 



34 HEALTH AND SOCIAL PROGRESS 

and ethical character. It does not, however, relieve sym- 
pathy from its fundamental character of being self- 
centered, since the sympathetic pain experienced by the 
almsgiver, or the possible reward of almsgiving, are at 
least subconsciously motives to action. This could hardly 
be different under a civilization whose characteristic fea- 
ture was suffering— politically, from oppression, hence 
submission to duty ; economically, from constant deficits 
as proved by numerous famines, hence the worship of 
various deities, like Ceres, who were supposed to give 
bountiful harvests; physically, from almost constant 
diseases and under-feeding, hence the low tone of 
morality based chiefly on utilitarianism of a narrow type. 
The whole object of life was one continuous attempt on 
the part of the individual and society to escape from 
intolerable conditions. Is it any wonder that morality 
was not and could not be buoyant and social, but had to 
be negative and sel f -centered ? Uncertainty what the day 
might bring forth politically, economically, or for personal 
well-being, kept the people in constant turmoil and made 
them think of themselves and their safety of life and 
property. At such a time the relief of siiflFering was of 
necessity a great virtue, since the individual was unable 
to think of others, even though reminded that he himself 
might soon need help. Take as an illustration the treat- 
ment of slaves. It was on the whole good, not primarily 
for economic reasons, but chiefly for sympathetic reasons, 
since in the constant political changes no one knew who 
might be a slave tomorrow even though he be a master 
today. In the constant political changes, empires were 
often overthrown during a few days, and the ruler of 
today might be dragged behind the chariot of a victorious 
enemy tomorrow, irrespective of whether he came from 
within or from without. Even the proudest nations of 



HEALTH AND RELIGION 



35 



antiquity were sooner or later reduced to a x:ondition of 
servitude, and some of the greatest men suflFered the 
humiliation of being made the butt of vulgar remarks on 
the part of the victorious mob. 

A few words may, perhaps, be necessary here to avoid 
misunderstanding in regard to the moral ideals of 
Christianity. The statement has just been made that its 
morality was self-centered. This is true as far as its 
de facto statements are concerned. The Golden Rule, 
while a good principle for a narrow morality, is neverthe- 
less self-centered and only incidentally social, since the 
individual is asked to act or refrain from action on the 
basis of the eflFect it would have on him; this rule in- 
volves, consequently, a calculation of ultimate effects. 
But this is exactly what a man of low vitality always does 
and has to do. Being always conscious of his limitations, 
he must ask himself what the ultimate effects of his 
actions will be. And he does that even while his vitality 
is still fair. A man like Cassius with his "lean and 
hungry look " always thinks too much about himself, and 
never rises above that level in his ethical motives ; neither 
does the average man who is firmly convinced that " hon- 
esty is the best policy." When a man's vitality has sunk 
lower still and he has become more self-conscious, he acts 
from more narrowly selfish motives ; i.e., he schemes with 
great cunning to get what he wants ; or in a blind rage, 
when a particular organ has become the center of his 
gravitation and is uncontrolled by the brain, he goes ahead 
and takes what he wants. This man of lower vitality 
acts in a decidedly unethical manner, while the other, 
still able to calculate, may keep within the limits of the 
permissible. This is, however, not social action, be- 
cause it is too largely self-centered. True social action 
can come only from an abundance of vitality, plenitude 



(T 



56 



HEALTH AND SOCIAL PROGRESS 



HEALTH AND RELIGION 



37 



of power, and the happiness of high tension. Such a man 
must act because he has a desire for function; and he 
must act socially, because his actions are not self- 
centered; he is usually unconscious of his body. He is 
full of joy and confidence, and imparts these to others 
— not deliberately, but because these qualities are con- 
tagious. When he becomes clearly conscious of these 
powers, he recognizes that they involve a responsibility, 
and he deliberately controls his actions in such a manner 
as not only to avoid harm, but to increase joy and happi- 
ness among his f ellowmen. He inverts Kant's categorical 
imperative, and says to himself : Thou must, because thou 
canst ! no matter what others may do. 

It seems to me that the true ideals of Qiristianity are 
identical with those of the healthy man. When Christ 
said : " For this purpose have I come into the world that 
they might have life, and have it more abundantly," or 
when we are admonished to become " co-workers with 
God" (I Cor. 3:9), we have a positive ideal placed 
before us ; an ideal not only moral because such action is 
best, but social because the abundance of life and power 
within us seeks an outlet in action which is wholesome 
and implies cooperation with God — the source of all be- 
neficent power according to Christian teaching. 

Unfortunately this positive ideal has never had much 
sway in Christian ethics, and could not have under the 
universally prevailing conditions of low vitality. When 
everybody has less vitality than his own needs demand, 
individuals as well as societies must form ethical codes of 
a negative character or a narrow morality, based 
primarily on utilitarian principles, such as the Golden 
Rule. With increasing health through better food and 
better control of germ diseases, such a code proves in- 
creasingly less satisfactory. Men in good physical and 



mental health want positive action, not merely escape 
from evil or from illness, since they are not conscious of 
any lack of power as the ill or underfed man always 
is. They are confident and self-reliant, and feel capable 
of coping with the difficulties in their path ; indeed, they 
rejoice in matching their physical and mental strength 
against obstacles. If this theory is true, it ought to ex- 
plain three facts in the modem world — declining church 
attendance among more vigorous men, continued attend- 
ance among the less vigorous, and the separation of phil- 
anthropic movements from the churches. 

That church attendance is declining, is almost a uni- 
versal complaint among the clergy, and the fact that 
various devices are adopted to attract men, furnishes the 
proof for its truth. These absentees are, however, no 
longer considered wicked, or even atheistic, for many 
good and capable citizens belong to this class. They will, 
moreover, send their wives and children to church or 
Sunday-school, give money toward its maintenance, and 
perhaps admit its necessity. What, then, is the reason 
for their non-attendance? It is not hostility, but simply 
a lack of interest in what the church offers. It oflFers 
them help, but they do not feel any need of it ; it proffers 
relief, but they are whole; it promises forgiveness, but 
they have no sense of sin. In short, the church proposes 
to give them what they believe they already have. They 
are, or think they are, able to look after themselves, and 
are confident that if they do all in their power to make 
the world better, they will be taken care of in the here- 
after. They favor church attendance for others, but feel 
no need for it themselves. All the various attempts to 
interest them seriously and personally fail, because no 
positive action is demanded of them. Hence many 
churches have adopted the device of giving these men 



38 HEALTH AND SOCIAL PROGRESS 

something specific to do — ^to organize a boys' club, teach 
a class of unmanageable boys, look after some weaker 
brothers, and other things ; but the interest lasts only as 
long as the task is unfinished, since they feel that religion 
as constituted in the past and largely at present, is based 
on the acceptance of something which they claim to pos- 
sess — wholeness. Fortunately the church begins to 
realize that these most valuable men have to be treated 
differently and a field for positive action is now offered 
to them along various lines. 

Church attendance is still good on the part of less 
vigorous men who feel the need of every possible as- 
sistance in their effort to become strong. It is this par- 
ticular class which is intensely religious at times, just 
because it is aware of its own instability and lack of self- 
mastery, due to low vitality. In his discussion of the 
religious temperament Sir Francis Galton says: 

"The result of all these considerations is to show that the 
chief peculiarity in the moral nature of the pious man is its 
conscious instability. He is liable to extremes— now swinging 
forward into regions of enthusiasm, adoration, and self-sacrifice ; 
now backward into those of sensuality and selfishness. Very 
devout people are apt to style themselves the most miserable 
of sinners, and I think they may be taken to a considerable 
extent at their word. It would appear that their disposition 
is to sin more frequently and to repent more fervently than 
those whose constitutions are stoical and therefore of a more 
symmetrical and orderly character. The amplitude of the moral 
oscillations of religious men is greater than that of others whose 
average moral position is the same."* 

It is in harmony with this reasoning to find that the 
most orthodox churches are the only ones that grow, 
because they promise the weak man every possible help. 
Wh^n seeking relief from his own instability, a man will 



HEALTH AND RELIGION 



39 



not stop to inquire into the ability to make valid the claim 
of assistance, but grasp at any proffered aid. The in- 
cantations of the medicine man are as good for this 
purpose as the unintelligible philosophy of so-called 
Christian Science, which owes its rapid extension pri- 
marily to its ability to cure people from imaginary ills and 
has received into its membership chiefly, if not exclu- 
sively, those who sought relief from some ailment. Many 
articles have been written on church attendance; but the 
fact remains that the denominations which promise most 
in the way of relief are increasing more rapidly than 
others which demand work.* 

The separation of philanthropic movements from the 
churches is increasing constantly. Not so very long ago 
the church was the only agency which administered relief 
to the various kinds of afflicted people. Now the State 
has taken up that function to a large extent, and numer- 
ous semi-public organizations look after every possible 
need. It may be said, with good reason, that the church 
initiated most of these movements, that they are still 
managed chiefly by religious people, and that it is not 
her function to do the work of the community. All this 
is true. Yet it is significant that the church has failed 
to keep these men and movements within her borders in 
all countries except Belgium and the Roman Catholic 
part of Germany, where the work is chiefly that of relief. 
Under the guidance of modern philanthropy, assistance to 
those in " need, sorrow, sickness, or any other adversity," 
has not only passed from the church, but has changed in 
character; it aims primarily at prevention instead of 
cure, hence the innumerable movements to make people 
more intelligent, more moral, and — more healthy. The 
public baths, the play-grounds, the medical attention for 
school children, the school luncheons, the shorter hours 



# 



40 HEALTH AND SOCIAL PROGRESS 

for factory employees, the improved sanitary conditions 
in the factories, the larger wages — all tend to better 
health, although perhaps unconsciously on the part of 
those who promote them, since health has not yet been 
recognized in all its bearings. The reason for this change 
in philanthropy is not far to seek. 

Well-doing does not come to the social man as a duty, 
but rather as an opportunity to exercise his powers, which 
he delights to do ; hence he is not satisfied with the relief 
which has to be repeated tomorrow. He looks into the 
future, because his abundant vitality prompts him to 
devise ways and means for increasing joy in the world ; 
and this attitude leads inevitably to prophylactic meas- 
ures. The older civilization was characterized by the 
saying: "Sufficient unto the day is the evil thereof," 
because it could not possibly cope with other than im- 
mediate needs ; the newer joyfully takes up the fight for 
the future. 

This is truly a new civilization, since in every direction 
we see prophylaxis taking the place of cure — in medicine, 
in conservation of natural resources as well as the health 
of human beings, in the lessening of human toil through 
machinery, in the attempt of the various "Sunshine 
Societies " to spread joy in the world. It is perhaps this 
attitude of modern man which explains the strong social- 
istic tendencies both among the rich and the educated 
in England and America, since socialism offers the 
most complete program of any party for prophylaxis 
along every line, and — oh, how a healthy man hates 
patch work; he would rather cut out of the whole 
cloth. 

This new attitude is possible only on the basis of better 
health, i.e., freedom of action through surplus energy, 
which expresses itself in all kinds of experimentation. 



HEALTH AND RELIGION 



41 



The old attitude was conditioned by low vitality, because 
people were, and perhaps had to be, self-centered, since 
they were always conscious of their bodies; hence they 
had to content themselves with preserving what they 
had, and to ward off evils or seek relief from them. 
They lacked, in other words, aggressive health, and con- 
sequently aggressive mentality. For the two are, to a 
certain extent at least, identical. The modern world has 
generally adopted the saying of the classical world, mens 
sana, in cor pore sano; but what was formerly only an 
inference from observation has been established as a 
scientific truth by modem medicine. Almost every day 
produces new proofs to the effect that a poorly nourished 
or a diseased body is the host of low or erratic mentality. 
The mind of a healthy man need not be that of a genius ; 
it is, however, balanced and open to all good influences, 
because based on aggressive vitality which seeks an outlet 
for action. But an active, circumspect, clear-visioned 
mind is more important from a social and economic point 
of view than the acerbities and vituperations of a great 
intellect, clad in pompous and often unintelligible sen- 
tences. As a rule, the best work of the world in philos- 
ophy and science has been done by men in good health. 
An attempt will be made to prove this statement in a 
later chapter. The theory of mens sana, in corpore sano 
is, moreover, independent of any particular metaphysical 
doctrine. If, according to the theory of parallelism, body 
and mind are independent, the body is still the medium 
through which the mind must express itself ; if the ma- 
terialists should be right, the mind would be merely a 
special product of matter, and would be dependent on the 
proper functioning of the organism; if the idealists are 
correct, the body would be a special form of mind, but 
still its only known agent for manifesting itself. Even 



w 



ff 



42 



HEALTH AND SOCIAL PROGRESS 




the idealist Emerson said : " Give me health and a day, 
and I will make the pomp of emperors ridiculous." * 

Lack of aggressive, or even good health, has had an 
important bearing on civilization, since man has nowhere 
risen much higher than savagery where conditions were 
unfavorable to the development of at least medium vital- 
ity. What then are the factors of good health ? 

♦The change from the old to the new religious attitude is 
strikingly illustrated in the history of the Young Men's Chris- 
tian Assocation. Not long since its diluted evangelism was 
looked upon with mild tolerance by the more vigorous men and 
women. Then a genius, discerning the signs of the times, 
brought about a change to an active and aggressive Christianity. 
At once the Y. M. C. A. leaped into the respect and admiration 
of the community, as is shown by the two campaigns for money 
in 1917. One of the wealthiest church organizations in the 
U. S. finished a year's active compaign for a pension fund 
for ministers, and raised $8,000,000 instead of $5,000,000. The 
Y. M. C. A. got $53,000,000 in a week, and $7,000,000 more in 
the weeks following. Business men were enthusiastic about its 
positive and practical religion, and subscribed liberally. 



CHAPTER IV 

FACTORS OF HEALTH 

The first factor of health is food. Nature-peoples are, 
as a rule, poorly fed. Their meals are irregular, generally 
poor in quality, and often insufficient in quantity. The 
roots, berries, and other foods which nature furnishes, 
are usually poor in nutritive qualities. Hence the savage 
is habitually underfed, since the system is starved even 
though large quantities of coarse food be taken. This 
simply means that the digestive organs are burdened with 
material which does not nourish, and causes a distension 
of the abdomen, as may be witnessed almost anywhere 
among the poorer classes of China, India, Turkey, 
Rumania, Russia, and some parts of Austria-Hungary, 
not to speak of countries in which savagery still prevails. 
When a good meal can be had, as after a successful hunt, 
the savage eats voraciously and without proper mastica- 
tion ; hence digestion is interfered with in a different way. 
The system is in a chronic state of starvation, and no 
proper vitality can be built up. This fs true even in 
civilized countries among the poorer classes whose food 
supply is deficient in quality and quantity. 

The second factor is housing ; that is, anything that is 
necessary for protection against the inclemencies of 
nature. Little clothing may be needed in the tropics 
owing to the heat, but protection is necessary against the 
numerous disease-carrying insects. The Eskimo is well 
provided in regard to clothing, but his igloo or snow-hut 
compels him to live in vitiated air a great part of his 

43 




* 



44 HEALTH AND SOCIAL PROGRESS 

life, similar to the overcrowding in the tenements of 
large cities. 

The third factor is salubrity of climate. Where en- 
demic diseases exist, the good effects of food and housing 
are often nullified. A region may be fertile and produce 
all kinds of food, the climate may be mild, but endemic 
diseases, e.g., malaria and hookworm, will keep vitality 
at a low ebb. 

The fourth factor is heredity. With the inheritance 
of a good constitution a man may often be able to over- 
come the adverse conditions of the other factors, although 
he is likely to keep merely alive and refuse to succumb. 
With low hereditary vitality, a man is always handi- 
capped, even though the other three factors be favorable. 
This is proved by the fact that life insurance companies 
will refuse policies to people in whose families certain 
diseases have occurred. When the other three fac- 
tors are unfavorable, heredity is likely to be very 
poor. 

The question concerning the relative importance of 
these factors is not decided, and is, perhaps, of more 
academic than practical interest. Biology is apt to lay 
stress on heredity, geography on environment, including 
food, climate, and housing. These two factors have been 
on the whole the chief agencies in developing man. 
Heredity has been the variable factor— shifting, 
plastic, progressive, or retrogressive; environment has 
been the constant factor— persistent, continuous, omni- 
present, immutable. Man is always under the influence 
of his environment; it never sleeps. Yet all the influ- 
ences of environment will not explain the difference be- 
tween the Greeks of today and those of antiquity. The 
human factor surely claims attention, even though it be 
floly a variable influence over against the immutable one 



FACTORS OF HEALTH 4S 

of nature. The French had to give up digging the 
Panama Canal, because malaria and other tropical 
diseases killed about one-quarter of their employees every 
year. When the Americans went there in 1905, the Canal 
Zone was still the area of pest-ridden seaports, jungles, 
and marshes which it had been from time immemorial' 
Yet we have built the Canal by reducing the death rate 
to that of the healthiest cities in the United States. The 
variable human factor has triumphed over the immutable 
one of nature. It is in vain, then, to deny the efficacy 
of either factor. Each plays its role in the making of 
human history. But each enters into the problem of 
health, since that depends on both heredity and environ- 
ment. 

Suppose that environment be granted all that its advo- 
cates claim ! Wherein does its influence ultimately con- 
sist? A valley may abound in the most varied and nour- 
ishing foods and in perennial sunshine; it will yet be 
uninhabitable for human beings if its soil sends forth all 
kinds of poisonous germs. A country may be bleak and 
cold, still people will live there if they are able to provide 
the minimum of food. The geographical factor resolves 
Itself ultimately into one of health ; and this has been the 
most important factor in man's rise above the state of 
nature. 

The effects of vitality on civilization are both numer- 
ous and significant. Whatever the causes may be, low 
vitality means either low or erratic mentality. We are 
concerned here only with the former ; the latter will be 
considered in the chapter on Health and Originality. 
Low vitality always means inability to adjust oneself 
to one's environment, or to control it. Even adjustment 
to unfavorable conditions implies, however, low men- 
tahty; the animal and the savage are ruled by their en- 



46 HEALTH AND SOCIAL PROGRESS 

vironment, civilized man controls it. Why this differ- 
ence? 

Animals have perfected certain instincts which are, as 
a rule, sufficient guides to their actions, and keep them, 
when in a normal condition, in fair health. They act 
with almost automatic precision, and thus save the ani- 
mal a vast amount of useless expenditure of energy in 
mere trials to do something in a new way. But just be- 
cause the reactions of animals are fixed, progress is 
barred and further development practically impossible. 
The honey bee is a good illustration in this respect. It 
has perfected the division of labor and everything is 
provided for the welfare of the hive. The arrangements 
for a communal life excite our admiration owing to their 
efficiency. Yet, there is no progress, because the various 
impulses which form the series of which each instinct 
consists are so fixed in their order that the bee cannot 
act differently without disaster. In other words, the bee 
has become a sort of living machine to do a certain kind 
of work ; it functions without choice, hence there is very 
little power of adaptation or chance for variation. This 
is strikingly proved by the facts that the workers stultify 
themselves to feed the queen and the drones; that they 
rear hundreds of males instead of a dozen or two— ample 
for the function they are to perform — and that they have 
repeated the same actions without any material changes 
since time immemorial. They are slaves to their instincts, 
subject to the food which a comparatively small environ- 
ment provides, and progress is barred. It is similar with 
higher animals, although the instincts are a little more 
elastic, giving a slightly larger sphere for choice and 
individual satisfaction. With this greater elasticity of 
the instincts was given the possibility of mind, and in 
proportion as we advance in the animal scale, mind be- 



FACTORS OF HEALTH 



47 



comes more prominent, until we come to man with his 
very much larger mentality. Just when and where this 
transition took place, is an unsolved problem, and may 
always remain so. Suffice it to say, that under unusually 
favorable circumstances the transition was made, and 
mind became for the first time an important item in evo- 
lution. For man, being equipped with but few and com- 
paratively inefficient natural weapons, had to depend on 
the development of his mind if he was to live. This was 
the more necessary, since the gain he had made was 
dearly bought — it cost him the inerrancy of his instincts. 
Being no longer compelled to react in certain prescribed 
ways, he had to think, plan, and scheme. But that re- 
quired relatively greater vitality or a surplus of energy, 
since the loss of the inerrancy of his instincts had de- 
prived him of the more economical and frictionless ex- 
penditure of energy. Thinking in its early stages in- 
volves more or less useless expenditure, since it must 
proceed by the wasteful method of trial and error; this 
is the case even today, a good illustration being furnished 
by a new medicine, salvarsan, also called " 606 " by its 
inventor because the previous 605 experiments had failed 
to yield the desired results. High vitality could not be 
developed, however, in the tropics where endemic dis- 
eases were constantly counteracting the favorable factors 
of an ample food supply and mild climate. Hence only 
one course was left open — migration northward into more 
salubrious regions. In these migrations, only those who 
had the relatively highest vitality could engage. They 
were, like the pioneers of later times, the strongest and 
most active and most intelligent. (See chapter on Health 
and the Tropics.) This was the first and most primitive 
method of controlling nature — ^by migration — a method 
which animals share in to a certain extent. These migra- 



II 



' 1 1 nss'! 



48 HEALTH AND SOCIAL PROGRESS 

tions opened up new possibilities to man. He had to meet 
new situations in the way of enemies, adapt himself to 
new conditions of food, cross mountains and rivers, and 
in a hundred different ways develop new aptitudes. 
Every successful attempt opened up new vistas before 
him, and every new contact with nature or other men sug- 
gested new developments. In proportion as he pro- 
ceeded into higher latitudes, his vitality rose, and he was 
thus better able to meet the demands involved in getting 
a living under the less prodigal climate of the temperate 
zone. He increased his control over nature, and became 
through increasing civilization less dependent on his im- 
mediate environment. The peoples who were unable or 
unwilling to migrate north, continued to live, but were 
hardly able to develop, and have remained in a stage of 
savagery or barbarism until today. And they are still 
almost entirely dependent on nature for all necessaries of 

life. 

Along with this control of nature through the develop- 
ment of the intellect went a liberation of himself from 
the thraldom of instincts which still survive in him, e.g,, 
for food and sex. These are practically inerrant in 
animals living in the state of nature, and are thus con- 
tributory to individual and social welfare. When, with 
the origin of man, mind assumed a more prominent part 
in evolution, it was at first primarily an abundance of 
feeling and imagination, controlled but little by reasoning; 
hence the numerous and often revolting orgies engaged 
in by savage and barbarous peoples. Occasional abun- 
dance of food, due to success in war or in the chase, al- 
ways led to extraordinary exhibitions of excesses in both 
of these instincts, and were frequently continued even in 
higher civilizations, e.g., among Phoenicians and in India, 
when the food supply was regular. The poor nutrition 



FACTORS OF HEALTH 



49 



of the savage produces an unstable mentality which ior 
clines to extremes of excitement and joy, or of depression 
and melancholy. With an increasingly regular and bet- 
ter food supply, the physical organism becomes more 
stable and more capable of self-control, and at least the 
worst irregularities in the satisfaction of these instincts 
disappear. This statement is borne out by the fact that 
modem medicine looks upon too pronounced irregulari- 
ties along these lines as due to malnutrition, if not disease. 
A brief consideration of morality will bring further 
corroboration of this reasoning. 

As his intelligence increased, man soon recognized the 
injurious effects of excesses both upon himself, and upon 
those surrounding him. He formed, consequently, a 
crude code of ethics, put chiefly in the form of prohibi- 
tions, and enforced conformance to them by various 
punishments. But there were always those who could not 
be prevented by any kind of penalty— even the most 
severe — from acting contrary to ethical demands. Were 
they unwilling or unable to obey ? The punishment meted 
out to them clearly shows the attitude of older civiliza- 
tions in regarding them unwilling and therefore responsi- 
ble; the modern attitude on the part of the enlightened 
just as plainly indicates that their shortcomings are con- 
sidered due to physical defects. 

" At the end of the best part of a life spent among prisoners, 
a prison surgeon declares himself to be mainly impressed with 
their extreme deficiency or perversion of moral feeling, the 
strength of the evil propensities of their nature, and their utter 
impracticability; neither kindness nor severity availing to pre- 
vent them from devising and doing wrong day by day, although 
their conduct brought upon them further privations. Their evil 
propensities are veritable instincts of their defective nature, 
acting, like instincts, in spite of reason, and producing, when 
not gratified, a restlessness which becomes at times uncontroU- 




.% 



11 



50 



HEALTH AND SOCIAL PROGRESS 



FACTORS OF HEALTH 



51 



able. Hence occur the so-called 'breakings out* of prisoners, 
when, without apparent cause, they fall into paroxysms of 
excitement, tear their clothing and bedding, assault the officers, 
and altogether behave for a time like furious madmen." ^^ 

The criminal is not necessarily endowed with bad quali- 
ties, but he lacks the coordinating power of a well- func- 
tioning brain. The defect may be due to some specific 
malformation, disease, or to malnutrition. Poor func- 
tioning in the case of the two former is so evident to any 
observer, that it need not be discussed. Concerning mal- 
nutrition, a few words are needed. The brain grows at 
a much smaller ratio than the other organs ; this seems to 
indicate that the vegetative functions demand an increas- 
ingly larger share of the nutrition furnished.** The 
organism must, first of all, live; whether its life is to be 
well-directed and efficient, is a secondary consideration. 
This is well illustrated by the fact that idiots, if protected 
against adversities, may live to middle age ; and that after 
the stage of active thinking and reasoning is passed in the 
case of some old people, the vegetative functions continue 
sometimes for a number of years. Hence the inference 
would seem justified, that the brain receives only such 
nutrition as is not absolutely needed for the maintenance 
of life. In other words, where general vitality is low, the 
brain is likely to suffer first and most ; and the cortex is 
likely to suffer most severely, since both the sensory and 
motor centers are needed for the mere maintenance of 
life. The power of coordination must, consequently, be 
small in persons of low vitality. And it is this particular 
ability which the immoral classes lack. They are unable 
to coordinate their actions to each other, hence the more 
or less pronounced impulsiveness of their behavior ; they 
generally react on the stimuli of a particular organ, rather 
than on the demands of the system as a whole, i.e., they 



are under the sway of an organ which demands and re- 
ceives more attention than it would receive in a well- 
balanced healthy organism; e.g., in the drunkard and 
dyspeptic, the stomach ; in the nymphomaniac, the sexual 
appetite. These people lack, consequently, the power of 
coordination, and act in a self -centered manner. And 
from that condition to selfish action, there is only one 
step. In the case of those suffering from malnutrition 
with its consequent low vitality, it is either a special organ 
that is at fault, or a general lack of vigor on the part of 
all organs, making impossible a proper nourishment of 
the brain ; hence a general lack of coordination, or hasty 
reaction on some external stimulus, due to the small in- 
hibitory powers of the brain. For the unity of the organ- 
ism not only suggests that the improper functioning of 
one organ affects all others, but also the special part of 
the brain with which it is in sympathy. " The internal 
organs are plainly not the agents of their special func- 
tions only, but, by reason of the intimate consent or sym- 
pathy of functions, they are essential constituents of our 
mutual life." " 

Summing up, then, we may say, that the moral element 
is an essential part of a complete and sound character, 
and is based on a sound body; it is the ability to 
coordinate one's actions to each other, and to those of 
other people. 

When this ability is of a high order, we have sociality. 
For sociality demands not only that the individual should 
correlate his actions to those of other people, but that he 
should do so in a vigorous and efficient manner. Nega- 
tive morality is still too frequent, and is the only possible 
thing for people of low vitality, as was shown above. 
Positive morality or sociality is possible only to those who, 
pwing; to large surplus energy, are able to coordinate io 



% 



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52 



HEALTH AND SOCIAL PROGRESS 



a comprehensive manner, accurately and quickly; and 
who have sufficient energy to infuse enthusiasm into 
others, and make them cooperate. A moral man may 
suggest new plans of action; the social man alone can 
unite the many in cooperation by virtue of his energy, 
which enables him to plan, scheme, and work for those 
whose vitality requires them to confine themselves to the 
most necessary activities. It is the vocation of these men 
to procure more goods than needed for immediate con- 
sumption, to provide some leisure for at least a small por- 
tion of the community, and eventually for all. 



CHAPTER V • i 

HEALTH AND CIVILIZATION 

In the course of history, the problem of leisure was 
solved through the warriors at first, or through the 
institutions of militarism and slavery. It was a crude 
and barbarous solution, but the only one that could be 
resorted to at that time. It is not a part of this discus- 
sion to show how slavery produced a leisure class and 
accustomed the vast majority of men to give up their 
wild and roaming life for that of contiriuous toil and 
labor under the lash of task-masters.^^ Our only concern 
is the fact that the most vigorous men physically were 
the agents of progress along this line. Whatever one may 
think about mere physical strength in modern times, it 
played a distinctly beneficial role in antiquity; and even 
Aristotle admits " that the conqueror is always superior 
in respect of some good or other; hence it appears as 
though force were never dissociated from virtue." " It 
is, of course, not to be expected that the savage who was 
physically strong, would work for others, since he was 
not sufficiently advanced in morality and sociality to do 
that. He made others work, and profited by their labor. 
This gave him some leisure. In many cases this was ill 
used; in a few, well used. The chief results were an 
increase in the number of the leisure class and a conse- 
quent division of mental work among its two principal 
sections — the warriors and the thinkers. 
The warriors, generally the physically strongest and 

mpst ^ptive, devpted themselves not tp war only, but tp 





54 HEALTH AND SOCIAL PROGRESS 

the development of industry and politics. They wanted 
military pomp and splendor, rich feasts and large estab- 
lishments ; in order to procure them, they had to develop 
whatever industrial resources were at their command, or 
call them into existence. King Solomon is a good illus- 
tration of this class, with the building of the temple and 
palaces at Jerusalem and summer cottages in the country. 
This industrial expansion necessitated political alliances, 
and so he formed a treaty with King Hiram, and estab- 
lished friendly relations with the kings of Egypt, Arabia, 
and other rulers to procure the products of their countries 
and protect his fleets and caravans. He is one of the 
few kings noted for his wisdom — if that is not merely 
attributed to him by the historians and courtiers who 
credited him with other men's wise achievements; for 
apart from the seventy-second psalm which bears his 
name, we have nothing direct from his pen; and the 
authorship of that is denied him by Biblical scholars. 

The chief work in mental development devolved, how- 
ever, upon the priests and upon the scholars — the latter 
being for a long time associated with religious institutions 
and having gained their independence only lately and only 
in the most civilized countries. These men made the 
art, poetry, philosophy, and science of those times. They 
were always a leisure class and in comparatively affluent 
circumstances, but rarely as strong and vigorous as the 
warriors. According to Professor Giddings, the scholars 
have as a rule medium vitality, while the warriors gener- 
ally belong to the high vitality class." The vast majority 
of the people, being slaves and toilers, poorly fed and 
housed, had low vitality. This fact explains such vic- 
tories as those at Marathon, where a handful of intelli- 
gent and vigorous Greeks defeated a large army of igno- 
rant slaves with low vitality, since one hundred slaves^ 



HEALTH AND CIVILIZATION 



SS 



with systems habitually on the defensive and without 
energy to strike a vigorous blow, were no match for 
even one Greek. The health and intelligence of the latter 
created confidence and a circumspect . attitude, the low 
vitality of the former a craven spirit which was ready 
to yield at the first onslaught. 

This division of mental work produced other results. 
With the low vitality of primitive groups due to poor 
food, there could be no great enterprise. They merely 
wandered about to find food and avoid, as far as possible, 
encounters with other groups. When, owing to slavery, 
the warriors were better fed, their enterprise increased; 
they began tp love exploits and battles; they deliberately 
set out on far journeys into unknown regions, because 
their surplus energy gave them confidence and self-re- 
liance in any circumstances. These war-like expeditions, 
whether t^ ey resulted in permanent settlements or were 
only of a temporary nature, became the means of mixing 
and amalgamating various peoples. It gave the kings 
and leaders larger visions, and the conception of world- 
empires arose in the minds of the boldest. Very nearly 
every one of the conquerors of antiquity had the ambition 
to include all peoples under his sway. The numerous 
failures at last suggested the idea of international law, 
the jus gentium of the Romans, and, consequently, that 
empire enjoyed a greater stability than any of its prede- 
cessors. This law was the direct result of conquests 
and of the endeavor to retain the fruits of victory as far 
as land and other possessions were concerned. A more 
important, because more permanent, result was the mix- 
ing of peoples which took place in the Roman empire. 
In this process of assimilation various new traits were 
formed, most of which were good when not too divergent 
types mingled — ^as was the case until approximately the 



IT 





I 



56 HEALTH AND SOCIAL PROGRESS 

beginning of the Christian era ; later, when types of all 
kinds mixed, they were socially bad, because the lower 
people infused their low vitality into the already depleted 
stock of the Romans, who had lost their ablest men on 
various battlefields. This has been the case with every 
nation that has engaged in too protracted warfare. On 
the whole, the eflfects of mixture were, however, good, 
since more vigorous races resulted, and the mind of man 
was tremendously stimulated. It was through this pro- 
cess that means were eventually found for liberating a 
larger number of people from the hardships of manual 
toil. This was through the invention of machinery. 

Modern industry is possible only through the inven- 
tion of machinery, and this was dependent upon the 
leisure of the few procured through slavery. It is not 
necessary to go into any details about the successive and 
wonderful inventions and discoveries in science and in- 
dustry ; suffice it to say that whatever objections may be 
raised against machinery, it has procured comparative 
leisure for a much larger number of the population, has 
been the means of improving health, and has thus made 
civilization possible on a much wider scale. For civ- 
ilization has always been threatened chiefly by poor 
health. 

What, then, is civilization? Civilization means the 
translation of the subjective good into the objective good ; 
or, to be more exact, it is the process of transforming the 
subjective conception of the good into objective practical 
good. This means simply that civilization is the attempt 
to ameliorate hardships, improve conditions, and eventu- 
ally eliminate the worst evils, so that every man may 
live a life worthy of a human being. Or, to use Pro- 
fessor Patten's phrase : " It is the transition from a pain 
economy to a pleasure economy." 



HEALTH AND CIVILIZATION 



57 



Two things only need special notice in this definition : 
the conception of the good, and its translation into objec- 
tive good. The first depends largely on the mental state 
of the individual. If he is ill, or at least in poor health, 
relief will seem the greatest, if not the only, boon to 
him, and he will conceive civilization as a process of 
relief or redemption from evil. Again, if his mentality is 
narrow, he will conceive it as applicable only to his clan, 
tribe, or nation. Finally, if his mind is of a low type, 
civilization will mean to him only creature comforts. The 
second item, i.e., the translation of whatever conception 
of civilization one may have into objective good, is 
primarily a matter of economic and industrial conditions, 
based on science. A few words concerning these points 
may be appropriate here. 

There could be no true civilization in the past, since 
at best only a few of these conditions existed in any 
nation. As has been mentioned before, the history of 
the past has been largely dominated by the conception of 
relief or redemption from evil, because the health of the 
people was generally poor, and they lacked therefore a 
sense of confidence and self-reliance. Civilization was 
conceived in negative terms. This is evident when we 
look at the Hebrew and older Christian ideals. The 
Jewish theocracy pictured the Hebrews as utterly de- 
pendent on Jehovah; hence any misfortune coming to 
them was attributed to Him as a punishment for their 
sins, while any good fortune was looked upon as a 
reward for obedience to His laws. The two dominant 
notes of the Old Testament are, consequently, a sense of 
sin and one of gratitude. "Hear the prayers of Thy 
people, O Lord ! and when Thou hearest, forgive." " Oh, 
give thanks unto the Lord, for His mercy endureth for- 
ever ! " The Christian ideal has been dominated in the 



w 



58 HEALTH AND SOCIAL PROGRESS 

past chiefly by the spirit of the Litany : " Good Lord, 
deliver us ! " 

The religion of the Greeks was the only one which was 
comparatively free from this negative conception. They 
had many gods, and if one or two of them were hostile, 
others would be friendly. None had the monopoly, and 
if any serious difficulty arose about Achilles or Odysseus, 
the matter had to come before the council of gods. It is 
true, these deities were not models of purity and holi- 
ness, and were protie to pursue the lives of gentlemanly 
loafers, but they were at least whole and healthy, and 
represented to the Greeks beings of fairly unified char- 
acters. They were full of the joy of life, and gave men 
the means of enjoyment through arts and sciences. May 
this not be the reason for the positive development of 
Greek culture ? A healthy and, therefore, active race con- 
ceived civilization not merely as relief from evils, but as 
a positive joy, full of achievement and daring action, as 
the myths of Hercules and Prometheus amply prove. 
That health was the predominant cause in this blossom- 
ing of art and science may be shown by a reference to 
the later Greeks. With the introduction of malaria, health 
began to decline ; productiveness ceased, and the character 
of their deities changed almost at once. The Greek no 
longer looked to Olympus and its gods endowed with 
perpetual youth, and no longer hoped for his own pos- 
sible endowment with that quality as a demi-god; he 
exchanged the mountain of the gods for implacable Fate, 
and the joyous wholeness and unity of the human being 
for the dualism of Plato's " spirit and matter." 

This conception of Plato was introduced into Christi- 
anity, and, after being assimilated with the Hebrew 
sense of sin, has dominated western civilization until now. 
It is from this negative ideal that strong and hcallhy men 



HEALTH AND CIVILIZATION 



59 



are turning away at present; the reason of their indif- 
ference to the churches is not antipathy to the moral and 
spiritual teachings of Christianity, but rather apathy to 
a life of comparative inaction. For the man who is 
accustomed to depend on himself and to cultivate self- 
reliance for six days of the week in nearly every sphere 
of his life, finds it irksome on the seventh day to submit 
meekly without the right of cross-questioning, to the teach- 
ing of another. He finds, moreover, that the sciences, and 
medicine in particular, are working for a positive civiliza- 
tion, containing joy and happiness — a condition of 
things which will enable him to realize that he is not here 
merely to prepare for a future existence, but that this 
life is worth living for its own sake and ought to be 
improved as far as possible for everyone, instead of being 
made merely endurable. To this end he endeavors to 
introduce prophylactic measures into every department 
of life ; to improve conditions in accordance with an ideal 
to be attained in the future and not with that of some 
" golden age," irrevocably lost in the distant past ; to do 
and to achieve something that is worth while — not be- 
cause he is bidden to do so, but because action of a whole- 
some social nature is what he craves and best expresses 
his desire for an expansion of life. 

The narrowness of mental ideals has played a large 
role in the past. Whatever the best thinkers of any 
people pictured as a desideratum in national ideals, was 
always reserved for their own people, and others were 
excluded, unless it was for the purpose of serving their 
masters. " It is meet that Greeks rule over barbarians," 
are the words of Aristotle. Other nations were more 
narrow even than the Greeks. Such a conception of 
civilization was, however, not only narrow, but moribund, 
because no country is sufficiently equipped with all the 




60 HEALTH AND SOCIAL PROGRESS 

necessaries or comforts of life, or a full equipment of 
mental resources, to enable at least the majority of its 
inhabitants to develop their faculties. Hence, intercourse 
with other nations is imperatively necessary; it is, how- 
ever, impossible without the recognition of other people's 
rights, and a narrow national ideal always implies a 
denial of those rights. But people whose economic and 
emotional resources are small owing to poor health, are 
apt to be narrow in their political conceptions. We thus 
come back to the question of health from another point 
of view. 

Finally, if a man's mind is of a low type, civilization will 
mean primarily creature comforts. We have seen that a 
sickly or an undervitalized man cannot produce an active 
and vigorous brain, that he is self-centered and must 
confine himself to the most necessary activities. This 
means that such a person must of necessity seek creature 
comforts; owing to his inability to gain pleasure from 
vigorous and wholesome action, he must seek relief from 
his pains, or at least discomforts. For instance, lacking 
the good appetite of a healthy man, he must seek, if not 
delicacies, at least more choice and better prepared food. 
In regard to clothing, he must be more warmly dressed 
in winter, and must expose himself less to the inclemen- 
cies of the weather, than the well man. All this leads in- 
evitably toward a self-centered disposition and the seek- 
ing of comforts. It is true that we read occasionally of 
persons who even during illness do not forget the rights 
of others and are considerate of others' comfort. This 
is, however, always looked upon as an extraordinary 
exhibition of fortitude, due to an exceptionally well- 
trained will, or to social conventions. Just as the Indian 
under torture does not cry out owing to his training, so 
the sick lady or gentleman will be most anxious to avoid 



HEALTH AND CIVILIZATION 



61 



laying any extra work on the nurse. We are neverthe- 
less certain that they suffer, and we double our attention 
to spare them any pains and tactfully avoid even the sem- 
blance of making efforts for their comfort. The very 
fact that we praise such persons for their restraint and 
fortitude proves that the normal thing under suflFering is 
the seeking of relief and comfort through others, and 
that a self-centered mental attitude is unavoidable. The 
headaches, the nervous irritability of those in poor health 
are all continuous witnesses of this self-centered attitude. 
The pioneers, whether as scientists or missionaries or as 
pathfinders in new countries, prove this contention from 
a different point of view. They are usually men in good 
health, and seek, either through love of truth or of their 
fellowmen, or out of sheer abundance of vitality, to in- 
crease the world's useful knowledge and good will, and 
are rarely self -centered as far as their attitude is con- 
cerned. They act on the maxim, " It is more blessed to 
give than to receive," not because they are bidden, but 
owing to an inherent need and desire to express them- 
selves in socially useful action. A well man does not call 
on others for services; he considers it a glory to be in- 
dependent and a privilege to help others. The conception 
of what good means, is thus necessarily dependent on 
one's health. 

In regard to the second point, the translation of this 
good into practical, objective good, — a few words will 
have to be said. This depends, as was said above, on 
science as the basis of a higher industrial and economic 
system. The philosopher and the poet may tell us in 
glowing pictures what they conceive to be a social ideal 
of beauty and of perfection along every line, and they 
may stir our imagination with a desire to realize it ; but 
it is the scientist who makes possible its translation into 



L%V 



■ 



62 HEALTH AND SOCIAL PROGRESS 

objective reality. He needs, however, good health, since 
his senses must be keen and he must have a fine sense 
of balance and coordination. He cannot shape his system 
according to a priori principles and proceed to erect a 
structure of logic and plausibility upon it; he has to 
"check up" his ideas constantly by reference to new 
facts, and keep his mind open for other facts still to be 
discovered. His attitude has to be that of open-minded- 
ness, patience, ability to balance, willingness to change 
his conclusions and to retrace his steps. All these quali- 
ties demand good health. The irritable and " inspired " 
poet may, with a few strokes of his pen, give us a most 
entrancing ideal of what the future will bring forth in 
the way of beauty, truth, and goodness— the scientist 
alone, with his ability to stand shocks and disappoint- 
ments, to begin all over again, and to labor for years at 
a single small problem, is able to help us realize them, 
because he helps furnish the material basis for all cultural 
accomplishment and civilizational achievements. That 
such careful, patient, and often tedious work demands 
not only a fine nervous system but general fair health, 
will be discussed more fully in the chapter on Health 
and Originality. 

This attitude of the healthy man toward objective 
social action indicates the transition from a pain economy 
to a pleasure economy. Nature demands the satisfaction 
of certain physical wants, because these are necessary for 
the fulfillment of the functions of life. It is true that this 
furnishes a certain amount of physical pleasure, but it 
is very elementary and is more on the level of the animal 
than of man. When, for instance, the savage— half 
starved and more or less exhausted— succeeds in getting 
an ample food supply by killing a deer, he does not ob- 
serve any niceties about eating, but swallows the meat 



HEALTH AND CIVILIZATION 



63 



half raw and without much attention as to mastication. 
Nature imperatively demands food, and the savage meets 
that demand and so fulfills a natural function. The 
pleasure is rudimentary and animal, just as in the case 
of a hungry dog. Compare with that eating the feasting 
of a modem man— the elaborate preparations, the clean 
table linen, the attractive china, the flowers, the cheerful 
company, perhaps music, the dishes gathered from almost 
every comer of the globe — and you have a natural func- 
tion satisfied plus a purely human pleasure, because the 
physical has been raised through the accompanying men- 
tal satisfaction to a higher level which the animal can 
never attain. It is the same way with other things. Most 
men need shelter and clothing for protection against 
inclemencies of weather ; but what a difference between 
the cave or the rude hut of the savage and the mansion 
of civilized man, or between the dried and hard skin of 
animals used by the barbarian, and the artistic clothing 
of a woman of fashion serving the purpose of protec- 
tion much more successfully while at the same time 
satisfying an aesthetic demand. The savage may dream 
about feasting and whatever he considers fine clothing or 
a pretentious abode, but he is bound down to fulfilling 
nature's demands in the most primitive manner. It is 
civilization that has enabled mankind to advance from 
that stage of a pain economy to one of pleasure. And 
civilization is the result of health. 

We saw above that a man of low vitality can do but 
little more than take care of himself, i.e., provide for 
his most elementary needs, because there is no energy 
left for any attempt to improve his condition by planning, 
or experimentation. It was the leisure class, the vigorous, 
well-nourished individuals who had enough energy left 
after their daily work to scheme, plan, and experiment in 



^ 






i ] 



'■; j 



64 



HEALTH AND SOCIAL PROGRESS 



order to husband and increase nature's provisions and to 
raise life to a higher level through the development of 
art, science, and philosophy that produced civilization. 
The sick man even today is largely in the position of 
the savage; he eats, because he has to and takes no 
pleasure in meeting nature's demand. And he cannot 
contribute anything toward improving either his own or 
other people's condition ; he consumes but does not pro- 
duce. Where there is, however, a large number of 
people who consume without producing, civilization is 
impossible ; and where only little more is produced than 
necessary, it is in a precarious condition; because the 
translation of the conception of the subjective good into 
objective good means in terms of economics a greater 
production than is necessary for immediate wants, and 
thus the procuring of leisure or exemption from too ex- 
hausting toil. It is plain that the sick man cannot do 
that, and it takes but little reasoning to see that the 
undervitalized man cannot do it either. The latter works 
uneconomically, because he has to force himself, and is 
thus soon exhausted, and mighty glad to stop when his 
immediate wants are met. The advance of civilization is, 
thus, always dependent on the health of the people. 

This may be illustrated by a few references to nature- 
peoples. They are seldom regularly and sufficiently fed ; 
it is usually a case of starvation or of over-indulgence 
when plenty is to be had; the Igorots of the Island of 
Luzon consider it bad manners to leave any eatables for 
tomorrow. Under these circumstances no higher or even 
medium vitality can be developed, and consequently no 
surplus energy for an advance socially or mentally. En- 
demic diseases are another cause of keeping vitality down 
to its lowest level, and nature-peoples are, as a result, 
condemned to a pain economy. Being constantly faced 



HEALTH AND CIVILIZATION 



68 



with starvation, and therefore always more or less surly 
and morose owing to poor health, it is small wonder that 
many nature-peoples have invented barbarous methods 
of getting rid of the aged or of superfluous children. 
Their morals are merely a result of their poor health. 
A hungry man knows no mercy, and a sick one no com- 
passion. Whatever of song and of poetry, art and social- 
ity existed among nature-peoples, was produced at the 
rare times of plenty when men were happy because the 
craving for food had been satisfied and when, conse- 
quently, a slight excess of energy had been produced. 
No people has ever succeeded in rising above the level of 
savages unless it possessed at least fair health; where 
either economic or climatic conditions prevented health, 
no civilization could arise; and where it had arisen it was 
doomed whenever new conditions arose which under- 
mined health. 

Health is, thus, the principal index to civilization, be- 
cause it shows control over nature by society as a whole, 
and ability on the part of the individual to utilize these 
means of control for his own benefit. This control im- 
plies the ability to secure a suitable supply of food as 
regards quantity and quality, to counteract or avoid the 
effects of endemic diseases, and thus to lay up a store of 
surplus energy. 

This control of nature demands work, i.e., the per- 
sistent and intelligent application of physical and mental 
energy toward a clearly conceived social end. Where 
human energy is not applied persistently but by " fits 
and starts," we have the wasteful expenditure of the 
savage who will dance for two or three days with but 
few intermissions until the point of utter exhaustion is 
reached. If he is not engaged in warfare at the time, 
well and good ; he can sleep and rest for a week or two. 




66 HEALTH AND SOCIAL PROGRESS 

until restored to his normal condition. If he has enemies, 
they will watch for just such an opportunity and over- 
come him easily. It seems to me that this is the explana- 
tion of the numerous cases where often a handful of 
men defeated a large army, generally after a period of 
orgies and carousals when energy had been fully ex- 
hausted, so that new emergencies could not be met. Such 
orgies preceding an attack are directly mentioned as a 
cause of defeat in a, number of cases, e.g., Belshazzar's 
fall, and the victory of Frederick the Great at Rossbach. 
Where the application of energy is not intelligent, we 
have mere toil which exhausts but produces very small 
returns ; slave labor and so-called " unskilled " labor is 
of that nature. It gives very little mental satisfaction. 
Where, finally, the end is not clearly conceived as social, 
we have either misdirected energy, as in the case of 
the older Japanese craftsmen who wasted several years 
on the production of an intricate toy, or the well-directed 
energy of the selfish exploiter who seeks satisfaction in 
domination over others. Another case is possible, 
namely, that of the pleasure seeker in abnormal excite- 
ment. A few words concerning each of these cases will 
be necessary. 

The persistent application of energy requires a good 
stock of vitality, since it is the continuous although less 
strenuous application that is tiring. Even such easy work 
as bookkeeping demands more energy than the average 
savage possesses. Such well-distributed expenditure over 
a long period of time requires an excellent control over 
one's whole body, and that is possible only with good 
vitality. The savage neither has the vitality owing to 
undernutrition or malnutrition, nor has he a sufficient 
control over his body, owing to his poorly constructed 
nervous system. Hence savages, barbarians, and even 



HEALTH AND CIVILIZATION 



67 



semi-civilized peoples have never been able to work, and 
wherever they were forced to do so by stronger men, they 
succumbed in a short time. This is the primary reason 
for the rapid disappearance of nature-peoples when com- 
ing in contact with civilization, since, being deprived 
of their former means and methods of living through the 
chase, and unable to create a sufficient amount of energy 
suddenly, they were imable to adapt themselves to new 
conditions and rapidly fell victims to exhaustion or 
diseases. Volumes have been written by well-meaning 
persons on the deliberate cruelty of civilized nations in 
killing off those on lower levels of civilization. The proc- 
ess of extinction is, however, inevitable, unless nature- 
peoples succeed in creating a larger amount of vitality 
which will fit them for work. It is not the gun of the 
white man which has exterminated the red and many 
of the brown races, but their inability to work, as may 
be seen by a comparison with the Mongols who, although 
not particularly well fed, have long ago acquired the 
habit of work, and are now becoming the competitors of 
the white man — successfully, too, wherever they are able 
to get better food owing to higher wages. 

The unintelligent application of mere physical energy 
is toil, and gives but little satisfaction to a human being, 
besides being unremunerative. We find, therefore, that 
countries like the Balkans and Russia in Europe, and 
large parts of China do not produce any high type of 
men among their peasantry ; because there is no satisfac- 
tion in merely meeting the demands of nature to live. A 
man must have something more than mere animal 
pleasures if he is to rise to a higher level of civilization ; 
he must take pleasure in his work, and express himself 
through it. That cannot be done through mere toil; 
hence the absence of inventions fpr the amelioration of 





68 



HEALTH AND SOCIAL PROGRESS 



economic conditions and the proverbial poverty of those 
countries. In England, Germany, France, America, and 
in Australia, men enjoy their work because there is a keen 
pleasure in mastering an intricate problem which taxes 
one's ingenuity; these countries have succeeded in re- 
lieving their people from mere toil by having it per- 
formed through machinery. True, there is a new danger 
lurking here, since many working men have become an- 
nexes to the machines which they attend. The remedy 
has, however, already been found in shorter hours and 
more varied means of enjoying leisure, both made pos- 
sible by the greater production of machinofacture over 
manufacture. The man who works only with his hands, 
rarely produces more than he needs; it is the machine 
which helps us to produce a surplus, and thus to create 
leisure. We are already meeting this problem of the 
possible deterioration of our working classes through the 
monotony of their employment by encouraging them to 
follow an avocation during their leisure hours, and thus 
developing those qualities which are not exercised in 
their occupation. Ideally, vocation and avocation should 
coincide, and man should find his greatest satisfaction in 
his work, and his keenest joy in making it more effective 
for himself and others. As yet, we are far from that 
goal ; but we have at least come to recognize it as attain- 
able. 

The more or less useless work of the Japanese crafts- 
man is a thing of the past even in his own country, and it 
has rarely existed in modern Europe or in America. We 
are, however, threatened with a similarly useless, if not 
unsocial, form of expending energy. Many women and 
some men among our rich people are seeking pleasure in 
more or less abnormal excitement, and some men and 
women among the poorer classes imitate them. That 



HEALTH AND CIVILIZATION 



69 



such expenditure is harmful, is obvious ; that it is based 
on an insufficient state of health, is more difficult to 
prove. The attempt will, nevertheless, be made. 

In introducing the subject of health above, it was stated 
that the human body is a machine for action in order to 
preserve and improve life, and that the mind is the guide 
of actions along those lines. Hence, "as a matter of 
necessity, man is an agent. He is, in his own apprehen- 
sion, a creature of unfolding impulsive activity — * tele- 
ological * activity. He is an agent seeking in every act the 
accomplishment of some concrete, objective, impersonal 
end. By force of being such an agent he is possessed of 
a taste for effective work, and a distaste for futile efforts. 
He has a sense of the merit of serviceability of efficacy 
and of the demerit of futility, waste, or incapacity. This 
aptitude or propensity may be called the instinct of work- 
manship." " Wherever man violates this law of effective 
and useful action, and wastes his energies in futile effort 
his faculties will decline in power and the wrongfully 
used organs will deteriorate. And that is exactly what 
has happened to our American " idle " class, more par- 
ticularly to the newly and ultra rich women. They are 
supplied by their husbands with everything that money 
can provide; they have no responsibility, no inducement 
for useful effort of any kind, and nothing to occupy their 
ample leisure except amusement. Is it any wonder that 
their nervous systems deteriorate, and that more ex- 
citing pleasures are being sought by them so as to re- 
move that sense of tccdium vitco and of vacuity with 
which they are oppressed? Having refused in many 
cases to become mothers in order not to interfere with 
their bridge and opera parties, they have at last become 
unable to bear children, as Mrs. Olive Schreiner so ably 
argues in her Woman and Labor, The result is an 



70 HEALTH AND SOCIAL PROGRESS 

increased nervousness and restlessness, since no one can 
violate nature's laws with impunity, and the sense of 
having failed to fulfill any mission in life leads to still 
further cravings for excitements which violate the ordi- 
nary social laws. Hence an increasing number of in- 
discretions and scandals as reported by the daily press. 

At the other end of the social scale we have a similar 
nervousness for different reasons. Working girls get 
over-fatigued, and instead of seeking rest for their aching 
nerves, they attempt to drown their weariness in amuse- 
ments for which they are unable to pay. The result is 
increased excitability, depression, and eventually d^ener- 
ation. The only desire which these women — ^both rich 
and poor — ^have, is to out-do somebody else in extrava- 
gance, no matter what the cost. They must, consequently, 
be failures as wives and mothers, and this must eventu- 
ally affect the husbands who, tmable to pay the ever in- 
creasing bills, take to drink or run away. And the cause 
of it all is refusal to do useful work. 

The rich are beginning to recognize the danger threat- 
ening them, and are commencing to take a more vital 
interest in life, as the book of Townsend Martin on the 
Passing of the Idle Rich shows. The increased politi- 
cal activity of these women is to be welcomed from this 
point of view, because it gives them a new sphere of 
activities more wholesome than mere amusements. The 
more energetic women of this class, while single, are 
talking of definite work either in settlement or religious 
occupations, because they do not want to degenerate in 
the vacuities of so-called social life. Work is, thus, both 
the basis and the preserver of civilization. 

There remains one more type to consider briefly, i.e., 
the man who applies his energy both persistently and 
intelligently, but tinsocially and for the exploitation of 



HEALTH AND CIVILIZATION 



71 



others. If what has been said above is true, not much 
need be said about him. The healthy man we found to be 
social in his activities, due to his abundant vitality. Just 
because his body is a well organized and efficient unity, 
he organizes his work intelligently ; he has to work per- 
sistently owing to the necessity of giving a proper outlet 
to his surplus energy. There is, consequently, no waste- 
ful expenditure of energy in his case, but well-directed 
and effective activities along lines which seem worth 
while to him. His social nature impels him, however, to 
assist others, and his abundance of energy enables him to 
do so ; he will never resort, consequently, to the exploita- 
tion of others; that would not be in harmony with his 
nature and contrary to everything that gives him joy. 
If this be true — and it can be verified by observation 
every day — there is only one conclusion possible con- 
cerning the selfish exploiter — that he is not a healthy man. 
He may display tremendous energy in varied and fever- 
ish activities, but the balance of good health is lacking. 
There is a peace and contentment, a joy and happiness 
about the healthy man, which the selfish and feverishly 
active man does not possess. It seems as if he wants 
to get something which he lacks, not knowing exactly 
what it is; hence his incessant and carefully planned 
activity. The goal of his ambition is usually power, in 
whatever form that may exist in a particular society. 
Since he lacks the balanced harmony within himself, he 
seeks it in the control of others. The means for power 
and control vary in different societies, but the type is 
always the same, although the same type may be esteemed 
differently at different periods. Take the miser, for 
instance. In olden times Midas represents the type — 
the grasping, greedy king who would turn everything into 
gold to satisfy his lust for power. But it was deemed a 



It 



72 HEALTH AND SOCIAL PROGRESS 

vice in a king in those times to lust for power in the 
form of gold ; power through the feat of arms was the 
socially accepted means for power, and a king who sought 
It that way was never caricatured as was Midas. An- 
tiquity has only praise for the Hannibals, the Alexanders 
and the Caesars. During the Middle Ages the socially 
accepted means of seeking power was the church, and 
anyone seeking it through warlike exploits was censured 
unless It was in the service of religion ; the man who 
sought It in gold, was held up to public scorn at least, if 
he was not persecuted. Shylock is the picture of the 
selfish man of this period. In our own country the ac- 
cepted means of power is gold ; and lo and behold I what 
a change in popular esteem. The financier is no Midas 
much less a Shylock ; but the man who saves the countr)? 
m times of panic, barely escapes a public funeral, and 
certainly has many encomia written after his death. The 
type of the selfish man is always the same, i.e., he is the 
man who seeks power through well-planned action by 
exploiting others; if they are incidentally benefited by 
serving as his tools, he does not object. The point is 
that he seeks a balance and harmony in dominating over 
others, because he lacks these qualities. The interesting 
thing from our point of view is that in some way the 
Volksmtind always caricatured these men by ascribing to 
them some physical defect. Midas is thin, haggard 
poorly fed. and certainly mad. Shylock is old. almost 
doubled over from weakness, and certainly obsessed by 
money-madness. The financier of today, being the man 
who has chosen the accepted means of wielding power 
IS supposed to be sleek, well groomed, and the gentleman ' 
par excellence who favors kings and emperors with his 
visits. It is the warrior and the priest who are ill-favored 
by popular opinion. Anyone familiar with the popular 



HEALTH AND CIVILIZATION 



73 



press of Europe will recall the numerous and varied 
forms of ridicule to which they are subjected and the 
caricatures which almost invariably intimate some more 
or less hidden physical defect. The type has not changed 
psychically. As Alexander used the soldiers as tools to 
satisfy his selfish ambition for power, Napoleon used the 
French people for the same purpose; and it is rumored 
that certain war-lords of Europe would do the same 
if the means of seeking power had not changed from the 
mailed fist to the hand that signs checks.* If the type is 
psychically unchanged, may there not be some truth in 
the popular opinion that there is some physical defect 
lurking somewhere in the makeup of selfish men, indi- 
cating lack of health and balance? Health is, conse- 
quently, the basis of true social work. 

Civilization is, then, possible only on the basis of 
work — well planned, persistent, and intelligent. Only 
where work is recognized as the proper activity of every 
man, can there be true civilization. This work need not 
be manual labor, nor industrial or commercial pursuits. 
Any activity which is intelligent, and is directed toward 
raising society to a higher level, is work. And any society 
and individuals who recognize the necessity of work for 
the fulfillment of man's destiny here on earth, should be 
called civilized, no matter how poor they may be. The 
motive for work must not come, however, from the recog- 
nition of its necessity only; it must be an impulse from 
within urging man to exert himself intelligently and 
persistently. Where man works only because necessity 
compels him, he will never do more than meet that de- 

*This passage was written before the recent war broke out 
in Europe. It would be interestnig to study the health of the 
leaders in this movement. Concerning one it is definitely known 
that he has a poor heredity, is very excitable and erratic, and 
suffers from megalomania. 




m 




74 HEALTH AND SOCIAL PROGRESS 

mand, and will remain on a low level of civilization. 
Where he seeks an outiet for his surplus energy in well 
directed activity for social ends, and where he finds his 
joy and satisfaction in work, a surplus of goods will 
soon be produced, and the leisure which that makes pos- 
sible will soon enable him to create means of culture 
through art, science, and philosophy. Such activity is 
possible, however, only on the basis of good health. 

The sick man can evidently not engage in work. The 
undervitalized man may try hard and perhaps wear 
himself out in his endeavor, but his work will be ineffi- 
cient. As a matter of fact, the so-called incompetents 
consist largely of this class. Only healthy men have the 
true impulse for work; only they work efficiently, and 
only they produce more than is necessary for their own 
needs. And only such workers can enjoy a true self- 
respect. The man who lives on other people's work is a 
parasite, whether he is a tramp or a millionaire; he is, 
consequently, dependent on the exertions of others, and 
that deprives him of the ability to be self-respecting. 
The man who does not " pay his board to the world " 
must get someone else to pay it for him. That means that 
the wheels of progress are retarded to that extent, be- 
cause that board must be paid. The parsimony of nature 
must be overcome, and it can be overcome only by paying 
a price in human effort with physical and mental energy. 
If a community has many parasites, it loses that much 
in actual work and puts a heavier burden on the others 
than they ought to bear. Worst of all, though, is the 
lack of development on the part of the idlers, since effort 
is necessary for development— direct, personal effort 
alone will unfold our powers, since this cannot be done 
vicariously. Our development is, moreover, the only thing 
worth while in life, and everything worth while must be 



HEALTH AND CIVILIZATION 



75 



paid for, and the price in this case is exertion. Where 
the energy for work is lacking, there may be exertion, 
but it will either be ineffective or so costly to the indi- 
vidual that development becomes impossible. Hence we 
come back to the necessity of heahh from another point 
of view. 

What do we mean by development ? The development 
of an individual means, briefly stated, his growth into a 
social person. Professor Giddings says: 

"The true social nature is susceptible to suggestion, and 
imitative and thereby capable of learning from fellow-beings. 
This capacity is sufficient to make the social individual desirous 
to live at least as well as the fairly successful members of his 
community. He desires to enjoy what others enjoy, to do 
what others do, and to act as others act. 

"The social nature, however, is to some extent originative. 
It not only learns from others ; it also teaches others. It makes 
new combinations of imitations; it makes inventions in the 
sphere of thought and conduct, and sets new examples. This 
it is enabled to do, because, by varied contact with many phases 
of life, made possible by wide association, it enjoys many 
different experiences which inevitably combine in peculiar ways 
with peculiar results in the life of each separate individual. 

"The social nature is judicious. It is satisfied that, on the 
whole, the average judgments of mankind are justified by ex- 
perience. It cannot, to be sure, be perfectly satisfied with any 
judgment, much less with all judgments. It is at all times ready 
to criticize, to direct, or to devise ; but this it does in no cranky, 
captious, or quixotic way. It assumes that, for the purposes 
of social unity and cooperation, men must respect one another's 
judgments; and that new beliefs can be made practically avail- 
able only as large numbers of men are converted to them. The 
individual, protesting alone against the opinions of his fellow- 
members of society, may possibly be right, and they may be 
wrong; but not until they are convinced of error can he wisely 
or rightly undertake to put his views into practical operation. 

" The social nature is tolerant. It has learned through social 
experience to give the same opportunities, immunities, and en- 



pi:. 



!!? 




II 



76 HEALTH AND SOCIAL PROGRESS 

joyments to others that it claims for itself. And not only as 
a matter of judgment has the social individual decided that 
toleration is wise, he has learned also to feel as an experience 
of his emotional nature that it is desirable and agreeable. 

"The social nature, however, is not merely tolerant in the 
negative sense of being non-aggressive; it is positively sym- 
pathetic, companionable, and helpful. It enjoys comradeship, 
communication, social pleasure, and cooperation. It would be 
unhappy in isolation and dissatisfied if at work in an absolutely 
individual way, without relation to the industry and patriotism 
of other men." i^ 

The only persons who can meet these descriptions are 
healthy men and women, since only these engage in 
spontaneous activity, enjoy the expansion of opportunity, 
and experience a keen pleasure in the increase of their 
power. This activity is not self -centered, just because 
their abundance of vitality enables them to share with 
others their own joy and happiness ; they would, indeed, 
be made miserable if they had to live in an atmosphere 
of gloom. Hence by virtue of their own nature they 
cheerfully scatter sunshine wherever they go. Their sur- 
plus energy enables them to associate with many people, 
enter many and varied activities, and everywhere to learn 
something new, because of their receptivity. The 
devitalized man must conserve his energy, is more or 
less concerned about himself, and he cannot with the 
best intentions "get away from himself." U under 
special cases of excitement he forgets himself, he mani- 
fests that somewhat boisterous hilarity which with women 
borders on and usually precedes hysteria. The friends 
of such people are not deceived, since they know that 
such expenditure of energy is sure to bring about ex- 
haustion and collapse. The healthy man increases in 
power as he associates with an ever larger number of 
people; since growth of personality is potaible only 



HEALTH AND CIVILIZATION 



77 



through exchange of views with others and through the 
polishing off of the sharp corners and edges of our 
individual nature. Applied to civilization .this means 
interdependence of peoples ; for, as individuals must learn 
to abide with each other by the circular movement of 
" give and take " in order to grow, so must nations enter 
into relations with each other on the basis of fair ex- 
change of their mental achievements as well as indus- 
trial. But travel, whether for commercial purposes or 
scientific investigation or for the pleasure it affords, is 
ultimately dependent not so much on the means of com- 
munication as on the health of the travelers and on that 
of countries. Persons of low vitality cannot risk many 
journeys, because they depend too much on the comforts 
of home ; healthy people do not visit regions infested with 
typhoid, malaria, or yellow fever. The Panama district 
was never visited by pleasure tourists until the last few 
years when the Zone had been made salubrious by Dr. 
Gorgas. Unhealthy regions prevent, moreover, the pro- 
duction of anything else than raw material, and thus even 
the commercial traveler is not attracted to them. Finally, 
owing to their dependence on others, devitalized people 
never develop that sturdy belief and confidence in them- 
selves, which are so characteristic of the healthy man and 
which are so necessary for new exploits as well as the 
undismayed pursuit of more usual activities. 

From whatever point of view we look, consequently, 
at the individual or society, the problem of health always 
confronts us ; and we may now sum up our results in a 
few principles. 

\. Law of Progress: Progress is possible only with a 
surplus of vitality over the immediately necessary activi- 
ties of life. 

2. Law of Work: Work in the sense of telic endeavor 



I 



I» 



m 



7B HEALTH AND SOCIAL PROGRESS 

and of the wisely controlled expenditure of energy is 
possible only with good health. 

3. Law of Social Personality: The individual can 
grow into a social personality only in proportion as his 
health permits him to enter into mutually helpful and 
sympathetic relations with others. 

4. Law of CiiHlusation: Civilization progresses in 
direct ratio to the interdependence of persons and 
peoples ; i.e., on the interchange of mental and industrial 
products which result from a healthy individual and 
social life. 

5. Law of General Development: Individuals and soci- 
eties develop in proportion to their growth in self-reli- 
ance ; and this depends upon their ability to attain health 
with the resuhant confidence in their ability to control 
nature and their own destiny. 







PART II 



SPECIFIC CASES OF HEALTH IN RELA- 

TION TO SOCIETY 



CHAPTER VI 






l|i 



HEALTH AND ANCIENT GREECE 

Man is bound to earth. Like Antaeus of old, he gains 
strength every time he touches her ; and like Brutus, he 
must recognize her as the mother of us all. In proportion 
as she is kind and liberal with her gifts, he prospers and 
develops, and in proportion as she is niggardly, he be- 
comes stunted in mind and body. Some mothers give too 
much, and spoil their children ; others give too little, and 
hinder their development ; others again give enough but 
not too much, and thus favor the development of initiative 
through ''mental and physical activity. So nature is a 
" lady bountiful " in some places, in others a hard step- 
mother, in others again a wise and kindly mother who 
knows that over-indulgence is evil and that niggardliness 
may prove disastrous to the welfare of her children. 
But however nature may treat her children, they are 
always her offspring, and bear the marks of her different 
attitudes in the tropics as much as in the arctics; for 
they can never completely free themselves from the in- 
fluences which she is constantly impressing upon them. 
This dependence upon natural influences has led social 
scientists to the conclusion that happenings in the social 
and political sphere are not the result of chance, of indi- 
vidual impulse or caprice, nor of the direct interference 
of an infinite, and often arbitrary power. History in 
our times is not written as that of Herodotus, or of the 
Chronicler among the ancient Hebrews, who ascribed 
every happening to the good or ill will of God. We 



w 



82 HEALTH AND SOCIAL PROGRESS 

have learned that nature is orderly because ruled by law ; 
and so we are learning that social happenings occur in an 
orderly and law-abiding manner, just because man is 
nature's oflFspring. We have not yet proceeded far 
enough in this new field to foretell with the exactness of 
astronomy the future of social events, but we know that 
the origin, growth, decay, or retardation of institutions 
may be aided or hindered by man according to his knowl- 
edge of nature's laws. In proportion as we realize this 
fact, shall we succeed in shaping our own destiny, — " to 
see in order to forsee " as Comte said, to avoid harmful 
things and provide for advantageous ones. 

Man's dependence on nature might be illustrated from 
many points of view, as Buckle, Ratzel, and Huntington 
have done. The only point with which we are concerned 
is that of health, and the Greeks and Romans will serve 
as a sufficient proof of its importance for national wel- 
fare. This statement should, of course, be understood 
just as it stands — importance for national welfare — since 
no attempt will be made to explain Greek and Roman 
genius from geographical conditions, because explanations 
of that kind are, to say the least, one-sided and forced, as 
the theories of Buckle and Ratzel prove. With our 
present imperfect knowledge of the relation of body and 
mind, it is premature to attempt an explanation of civili- 
zation on the basis of any one factor. Life is, after all, 
not a theory, but a bundle of facts. Until we know at 
least the majority of these facts scientifically, our theories 
will always be colored by our philosophies, and these 
represent distinctly individual views and not generally 
accepted theories of life. 

That health is necessary for civilization, the Greeks 
and Romans prove abundantly since no other peoples 
believed so strongly in the theory of Mens sana in 



I 



HEALTH AND ANCIENT GREECE 83 

corpore sano. Their training aimed at the best possible 
development of the body, and for a long time they suc- 
ceeded. Then a disease entered their countries, and 
attacked them, and as they were unable to cope with it, 
they lost virility and buoyancy of body and mind; the 
surplus of energy which had been stored up was soon 
exhausted, and the decadence of their civilization com- 
menced almost immediately. This disease was malaria. 
There were undoubtedly other diseases, both individual 
and social, which contributed to this result ; but we are 
unable to lay our finger as definitely upon them as on this 
particular disease. 

In an attempt to prove this theory, six questions must 
be answered: (1) Does malaria produce such deleterious 
results as the theory calls for? (2) Was there any 
marked deterioration of the Greek character at a par- 
ticular time? (3) Is there any specific cause that can be 
assigned as a reason for such a result ? (4) If malaria 
was the cause, when was it introduced? (5) How did 
it affect the Greeks? (6) Why were the effects so 
disastrous? The first of these questions has a general 
application, and the answer of modern medicine covers 

any people. 

(1) Does malaria produce such deleterious results as 

the theory calls for? 

A full statement by a physician, William H. Deaderick, 
who has been engaged in private practice in country dis- 
tricts, in the home of the severer forms of the disease in 
Arkansas, will serve the purpose of proving the disastrous 
character of malaria better than a discussion by a layman. 

"Malaria has been one of civilization's greatest foes, both 
in time of war and in peace. Where shot and shell have slain 
their thousands, malaria has slain its tens of thousands. Malaria 
is the chiefUin of the army of disease. Even Napoleon acknowl- 





ii\ 



84 HEALTH AND SOCIAL PROGRESS 

edged its supremacy when he wrote his minister of war on 
the occasion of the disastrous English Walcheren expedition: 
* We are rejoiced to see that the English themselves are in the 
morasses of Zealand. Let them be kept only in check, and the 
bad airs and fevers peculiar to the climate will soon destroy 
their army.* It is said that the French crowed over the expedi- 
tion ' with the force of reason, the bitterness of sarcasm, and 
the playfulness of ridicule.' How accurately Napoleon's pre- 
diction was verified is well known. 

" In the tropics, the man who works the soil digs his own 
grave. Gigantic commercial enterprises have been undertaken 
and then abandoned on account of the havoc wrought by this 
scourge. Only recently has it been recognized that the medical 
man must precede and prepare the way for the engineer and 
the laborer. 

"But warring and canal digging are not the only conditions 
under which the malarial tragedy is enacted. Within the family, 
at home, the disease appears in a varied succession of forms, 
rapidly fatal or slowly sapping the vitality, influencing the birth 
rate, longevity, and even the intelligence and morality of entire 
countries. 

" In highly malarial regions, as the mortality increases, natality 
diminishes on account of abortions and sterility. Premature 
senility is frequent and advanced age is not so commonly 
attained. 

"Malaria, leaving its subjects anannic and neurotic, is re- 
sponsible for inertia, loss of will power, intemperance, and 
general mental and moral degradation. Jones, who maintains 
that malaria was a potent factor in the decline of Greece and 
Rome, concludes that 'malaria made the Greek weak and in- 
efficient; it turned the sturdy Roman into a bloodthirsty brute.* 
Monfalcon attributed abortion, infanticide, universal libertinism, 
drunkenness, want of religion, gross superstition, assassina- 
tion, and other crimes to the direct influence of malaria. 

"Malaria costs the South incalculable wealth. Besides loss 
through untilled acres, diminished earning capacity, loss of time, 
and death, it produces in its victims a disinclination for work 
whose influence cannot be estimated in money. A conservative 
computation of the loss to the Southern States through malaria 
is fifty million of dollars, annually. 
"The importance to the world at large of the subject of 



HEALTH AND ANCIENT GREECE 



85 



malaria is evidenced by the fact that two of the seven Nobel 
prizes in medicine which have been awarded have been granted 
for discoveries in malaria, to Ross in 1902, and to Laveran 
in 1907.' 



18 



A third Nobel prize was awarded to a malaria specialist 
in 1906, namely Golgi. 

This general description of the effects of malaria may 
be supplemented by its special effects. These vary some- 
what according to climate, physical susceptibility, and 
type of fever. Quotations from Sir Patrick Manson will 
again best serve the purpose of showing the nefarious 
character of malaria. 

" But, as there may be an infinite variety as regards the num- 
ber of parasites present, individual susceptibility, concurrence 
of several species (mixed infection being far from common), 
or of several generations of the same species of parasite 
maturing at different times, there may be a corresponding 
variety in the clinical manifestations." 1® 

Of the " bilious remittent " form of malaria he says : 

" These bilious remittents are very common in the more 
highly malarious districts of Africa, America, the West Indies, 
India, and, in fact, in all malarious countries. They are not 
specially nor directly dangerous in themselves, but they result 
usually in profound anaemia, and are often but the prelude to 
chronic malarial saturation, bad health, and invaliding." 20 

Concerning " adynamic remittent " our author says that 
there are: 

"Cases which are characterized by fatuousness, restlessness, 
nervous depression, intense muscular and cardiac debility, pro- 
found and rapid blood deterioration . . . and a marked tendency 
to local gangrene." 2* 

Among the "pernicious attacks" there are various 
" cerebral forms " which are generally dangerous. 




\ i 



i (■ 




i 



85 HEALTH AND SOCIAL PROGRESS 

" Seizures of this description, if not fatal, may eventuate in 
permanent psychical disturbances. Temporary debility or even 
complete loss of memory may succeed severe malarial infec- 
tion." 22 

Similar statements are made about other types of 
malaria. The blood is attacked by the parasite and we 
have a deterioration and diminution of the red cor- 
puscles. Among the results of malaria Sir Patrick Man- 
son mentions enlargement of the spleen and liver, de- 
generation of the heart, and other after-effects. 

Dr. Deaderick thus describes persons suflFering from 
malarial cachexia. 

"The cachectic usually presents a singular appearance. The 
emaciated limbs are in marked contrast to the big belly, and 
the features are aged beyond the years. The most pronounced 
phenomena are the anaemia and the enlarged spleen. The red 
blood-cells may be reduced to seven or eight hundred thousand 
per cmm." *• 

The true mortality from malaria is difficult to esti- 
mate, because of the variety of forms which malaria 
assumes and its complications with other diseases. Dr. 
Deaderick states that out of 5,109,001 cases, 148,055 or 
2.89 per cent ended fatally. These figures report evi- 
dently light cases, since according to other figures given 
by him there were 7,205 fatalities out of 27,039 cases, 
or over 26 per cent; while different writers whom he 
quotes state the mortality from some forms of malaria to 
be as high as 50 per cent, and even higher.'* Concern- 
ing mortality from malarial cachexia; he says: 

" The mortality varies unaccountably from year to year, some 
seasons evincing a series of mild cases, others an appalling 
mortality. In a certain parish of Louisiana in 1867, many cases 
are said to have occurred, of which not less than 95 per cent 



HEALTH AND ANCIENT GREECE 



87 



died. Fisch, who placed the mortality on the Gold Coast at 
20 per cent, states that until two or three decades previously 
nearly all who were attacked died." 26 

Another dangerous characteristic of malaria is the 
impossibility of acquiring immunity from it, since very 
few individuals even among the negroes in Africa are 
absolutely immune, and this freedom from the disease is 
not hereditary. The negroes, the Chinese, the Malays, 
and other dark-skinned races enjoy comparative immun- 
ity, while 

''The inhabitants of the malarious districts of Italy, Corsica, 
Greece, Turkey, and other South European countries have in- 
herited no marked immunity from malaria in virtue of the 
thousands of years during which their ancestors lived in malari- 
ous districts." 2« 

Children up to three or four years harbor almost 
without exception malaria parasites. The proportion of 
infected children gradually becomes smaller until ado- 
lescence is approached, when the blood becomes prac- 
tically free from parasites and partial immunity is estab- 
lished. This process is, however, bought dearly, since the 
mortality in children native to highly malarious countries 
is very great. Concerning the health of the immunes 
authorities differ. Manson says : 

" It has often been remarked that these dark-skinned children, 
with enormous spleens and a rich stock of malaria parasites in 
the blood, run about fever-free, and apparently in rude health." *' 

Major Ross, however, says: 

"An intensely malarious locality cannot thrive. The children 
arc wretched, the adults frequently racked with fever, and the 
whole place shunned whenever possible by the neighbors. The 



t 



It * ■ 



f 'H 




88 HEALTH AND SOCIAL PROGRESS 

landowner, the traveler, the innkeeper, the trader fly from it 
Gradually it becomes depopulated and untitled, the home only 
of the most wretched persons."** 

Even if immune children enjoy rude health, their 
enormous spleens indicate a serious disturbance in the 
physical system, sufficient, perhaps, to prevent the build- 
ing up of a fine-grained nervous system which is neces- 
sary for the creation of a higher civilization. 

Of greater significance is local immunity, since these 
islands of malaria-free localities are important, as will 
appear later. Bermuda, Argentina, New Zealand, and 
the Sandwich Islands are remarkably exempt from this 
disease. Even in malarial countries such as India, im- 
mune localities are found, e.g., Kherwara in Rajputana. 
Generally speaking, high altitudes are relatively exempt 
even though surrounded by malarial lowlands. A few 
hundred feet in altitude may show a more marked dif- 
ference in the prevalence of malaria than as many miles in 
latitude. In the tropics where even high elevations do 
not have a low temperature, malaria may be found at 
elevations of 6,000 or 7,000 feet, and other circumstances 
may annul the advantages of elevation. 

"In Italy there are many malarious spots high up among the 
hills; the same is the case in India, and elsewhere in these 
elevated valleys which are also narrow, imperfectly ventilated 
and imperfectly drained." 29 

With the exception of these few localities, malaria 
is prevalent all over the tropics and in most parts of the 
temperate zones. Its debilitating influences have, in other 
words, been spread over the larger part of the habitable 
globe, as will be seen from the geographic distribution 
given by Dr. Deaderick.^® Summarizing this report, we 
find malaria to be very prevalent in the southeastern por- 



HEALTH AND ANCIENT GREECE 89 

tion of the United States, less prevalent along the At- 
lantic coast south of New York with increasing fre- 
quency as we go south. The Mississippi valley along 
both shores to the extent of hundreds of miles, is very 
malarious, as are all the Gulf States.* In New York, 
Pennsylvania, and New England autochthonous cases are 
found, while the shores of the Great Lakes and the 
Central States are comparatively free, with the exception 
of the lowlands. On the Pacific coast malaria is not 
frequent, but all the river valleys harbor numerous in- 
fected mosquitos. In Mexico severe forms of malaria 
occur, particularly in the low coast regions. The Atlantic 
side of Central America is most unhealthy owing to 
malaria, and the Pacific coast is only slightly less so. 

In South America the larger part of Brazil, Venezuela, 
Guiana, are highly malarious; Bolivia, Paraguay, and 
Uruguay are less infected, while Argentina is almost 
entirely free. The deep valleys of Peru, Ecuador, and 
of some portions of Chile are malarious centers. All of 
the islands in the Greater and Lesser Antilles are malari- 
ous, while Bermuda is practically free from this disease. 

In Europe, Great Britain is now free from malaria, 
and Germany has infrequent cases along the Rhine and 
Danube valleys; but Holland has many cases, both in 
its northern and southern portions, particularly on the 
island of Zealand. The valley of the Danube in Austria 
and Hungary has many cases of malaria, and many other 
portions of Hungary are heavily infected. In France, 
malaria is found chiefly in the marshy land along the 
west coast and in the south; Spain and Portugal have 

*The State of Mississippi reported 158,000 cases in IQI?- 
But this is only a small part of those occurring, since only about 
ten per cent of the physicians answered the questionnaire of 
the United States Public Health Service, and many more cases 
were not attended by physicians. 





90 



HEALTH AND SOCIAL PROGRESS 



'•I; I 



numerous cases in the coast regions and the larger river 
valleys. In Russia, malaria is encountered along the 
coasts of the Black Sea and the rivers which issue into it. 
Bulgaria is very malarious in its southern part, along the 
Danube and coast regions. Practically all parts of Italy, 
Sicily, and Sardinia are afflicted with this disease, and 
some portions of southwestern Switzerland. Greece is 
severely scourged with malaria, and in some parts 
scarcely any inhabitants escape. 

Few countries of Asia are free from this disease ; Asia 
Minor, Arabia, and Persia, the swampy regions of 
Afghanistan and Beloochistan have many and severe 
cases of malaria. The presidencies of Bengal and Bom- 
bay, the foothills of the Himalayas, and other parts of 
India are intensely malarial. Ceylon is endemic terri- 
tory, and so are Burmah, Siam, the Malay Peninsula, and 
French Indo-China. Some parts of China are intensely 
infected; Japan, Formosa, and the Philippines give rise 
to malaria. 

In Africa, the territory between the Senegal and Congo 
rivers is headquarters for a malignant type of this disease, 
while further south the cases become less frequent and 
severe. All along the east coast from Delagoa Bay to 
Eritrea is malarial country, including the larger part of 
Madagascar and Mauritius. The interior of Central 
Africa, excepting the high plateaus, is all malarious 
country. In the Nile valley the inundated portions are 
very malarious, and the disease abounds along the coast 
and in the marshes of Algeria. 

In Australia, malaria occurs all along the coasts, dimin- 
ishing towards the south. 

The whole of Canada, Norway, and Sweden, are 
practically free from the disease. These localities arc 
always looked upon as healthy, and are frequented by 



HEALTH AND ANCIENT GREECE 



91 



many visitors; and the inhabitants are usually energetic 
and well advanced in education. 

The zone of malaria is almost coincident with the 
tropics and the larger portion of the temperate zones; 
it has, consequently, been a danger and enemy of man 
since early times. The relief felt by physicians when 
this obstacle to good health was removed by the epoch- 
making discovery of Ross, and when the possibility of 
exterminating the disease was in sight, is perhaps best 
expressed by a quotation from Dr. Deaderick. 

"Undertaking the work at Manson's suggestion, and after 
several years (1895-1898) of toil and discouragement, Ross 
proved conclusively that certain species of mosquitos are con- 
cerned in the dissemination of malaria. The debt owed him 
by mankind was acknowledged by the gift of a Nobel prize; 
his own feelings over the discovery are expressed in these lines 
which he wrote: 



tt 



*This day relenting God 
Hath placed within my hand 
A wondrous thing, and God 
Be praised. At His command 



M t 



Seeking His secret deeds 
With tears and toiling breath, 
I find thy cunning seeds, 
Oh million-murdering death. 

*•'! know this little thing 
A myriad men will save; 
Oh, death, where is thy sting, 
Thy victory, O grave?'"" 

The first question having been answered, we may now 
proceed to the second in regard to the deterioration of 
Greek character at a particular time. 

(2) Was there a deterioration of Greek character at 
a particular time? 




•Mil. 






r. 



m 




I 



h; 



92 HEALTH AND SOCIAL PROGRESS 

In order to simplify the discussion of this question, 
a. caution should be inserted at the very beginning. 
Whether malaria existed in other parts of Greece prior 
to 500 B.C. is still a problem waiting for solution. That 
it did not exist in Attica is fairly certain, owing partly 
to its location and partly to the absence of references to 
this disease by Athenian writers. The testimony of the 
latter will be taken up later, but a brief statement must 
be made here about the location of Attica as favoring the 
theory that it was free from malaria. 

Attica was most probably one of those favored locali- 
ties just mentioned, which, owing to its situation, was 
free from this disease. The advantageous features of 
this situation are from the present point of view, two: 
a comparatively dry climate, and a location off the main 
road of travel between north and south. The former 
feature would be unfavorable to the development of 
indigenous malaria, the latter to its introduction from 
other regions. 

"In ancient Greece the fruitful plains of Thessaly, Boeotia, 
Elis, and Laconia had a fatal attraction for every migrating 
horde ; Attica's rugged surface, poor soil, and side-tracked loca- 
tion off the main line of travel between Hellas and the Pelopon- 
nesus saved it from many a rough visitant, and hence left the 
Athenians, according to Thucydides, an indigenous race.»2 

Athens will consequently be the only part considered 
in this discussion, since it is to her that we owe practically 
all the arts and philosophy, which have survived into 
modern times. 

Galton states that Athens built up, by a system of 
unconscious but judicious selection, a magnificent breed 
of men, which produced in the space of a century — 530 
to 430 B.C.— the following fourteen illustrious men. 



.'! 



HEALTH AND ANCIENT GREECE 93 

"Statesmen and Commanders.— Themistocles (mother an 
alien), Miltiades. Aristides, Cimon (son of Miltiades), Pericles 
(son of Xanthippus, the victor at Mycale). 

"Literary and Scientific Men.— Thucydides, Socrates, Xeno- 
phon. 

** Poets.— iEschylus, Sophocles, Euripides, Aristophanes. 

" Sculptor.— Phidias." ^a 

His argument is that a free-born population of about 
90,000 persons, within a century, produced an exceed- 
ingly large proportion of prominent men. This is cer- 
tainly true. But it is interesting to note that not a single 
man is included in that list after 430 B.C. He might, 
of course, have added Aristotle, Demosthenes, and a few 
others who lived later. In his mind he &ees, however, 
a sudden drop in the production of great Athenians about 
this time. And he proceeds to give his reasons for this 
result. 

"We know, and may guess something more, of the reason 
why this marvclously-gifted race declined. Social morality grew 
exceedingly lax; marriage became unfashionable, and was 
avoided, many of the more ambitious and accomplished women 
were avowed courtesans, and consequently infertile, and the 
mothers of the incoming population were of a heterogeneous 
class. In a small sea-bordered country where emigration and 
immigration are constantly going on, and where the manners 
are so dissolute as were those of Greece in the period of which 
I speak, the purity of a race would necessarily fail.*'** 

This quotation assigns two reasons as the cause of 
Greek degeneration : moral laxity and loss of social purity. 
The first reason has generally been employed by his- 
torians and moralists, and yet it is not true to the facts. 
Mental and moral degeneracy is an effect rather than a 
cause. People become mentally and morally unstable 
through loss of physical balance by means of illness and 






94 HEALTH AND SOCIAL PROGRESS 

disease, and immorality simply hastens dissolution al- 
ready begun. Lack of physical health is always the 
primary and principal cause, if we are to trust modem 
scientific investigations.* 

The second reason is more true to the facts, but the 
cause assigned for it is wrong. It is a sociological 
principle that men of a superior race do not marry 
women of an inferior race, unless women of their own 
race are not available ; only inferior men marry women of 
an inferior race when women of their own race are 
available. It may be granted that a number of Athenian 
women preferred the free life of hetaerae, but their 
number must have been small. The very fact, moreover, 
that they preferred that life, is an indication of their lack 
of physical and, consequently, moral balance. Breeding 
from them would only have hastened the process of de- 
generation. We have to fall back, therefore, on the argu- 
ment from lack of physical balance or low vitality which 
resulted from a disease newly introduced into Athens. 
It was the inability to account for the decay of Athe- 
nian genius on any other basis, which induced Mr. Jones 
and Major Ross to seek for some specific disease, in- 
troduced about this time, that might explain the decline 
of Athens. Mr. Jones found that immorality did not 
increase between 500 and 300 b.c, but that the character 
of the people changed — home-life taking precedence over 
civic life, sentimentalism replacing robust feeling in art, 
and pessimism supplanting optimism in philosophy. 

♦The grave injury of sexual immorality is due chiefly to 
venereal diseases, and of these syphilis is the more injurious 
owing to its hereditary and pervasive character. It was, how- 
ever, unknown in Europe before 1495 and cannot be charged 
with the extensive deterioration among the Greeks and Romans, 
although both were, at least in their later history, grossly im- 
moral. (See The Nation's Health, by Sir Malcolm Morris, M.D., 
New York, 1917, pp. 12-15.) 



HEALTH AND ANCIENT GREECE 95 

"There does not appear to have been any increase of immo- 
rality between, say, 500-300 b.c. But, nevertheless, morality 
changed. Home life took precedence of city life, patriotism 
decayed, and lofty aspirations almost ceased to stir the hearts 
of men. In art there appeared a tendency to sentimentalism; 
philosophy in many quarters became distinctly pessimistic. Some 
schools of thought actually regarded 'absence of feelings' or 
'absence of care' as the highest goal of human endeavor. 
Dissatisfaction and querulousness are marked characteristics 
of the age. By 300 b.c. the Greeks had lost much of their manly 
vigor and intellectual strength. 

'• The cause of this change appeared to the present writer to 
be partly the decay of religious feeling, and partly the growth 
of the human intelligence, which resulted in dissatisfaction with 
existing institutions. Doubtless both of these tendencies were 
factors in the change, but they did not seem at the time of 
writing the earlier essay, and they do not seem now, to be 
sufficient by themselves." ^^ 

Whatever one may think of the reasons assigned for 
the decay of Greek genius, degeneration is admitted to 
have begun about the year 400 b.c. This fact is, more- 
over, borne out by evidence of contemporaries, of whom 
Demosthenes may serve as a good example. In the first 
Philippic, delivered in 352 B.C. he thus addresses his 
fellow-citizens. " When, then, O Athenians, will you be 
about your duty ? Will you always roam about the public 
places asking one of another: What is the news? Ah! 
How can there be anything newer than the sight of a 
Macedonian conquering Athens and dominating Greece? 
I say, then, that you ought to equip fifty galleys and 
resolve, if necessary, to man them yourselves. Do not 
talk to me of an army of 10,000 or of 20.000 aliens that 
exist only on paper. I would have only citizen soldiers." 

In the third Philippic (341 B.C.), Demosthenes had 
reason to chide the Athenians for their continued in- 
action. " When the Greeks once abused their power to 




1 ; 




96 



HEALTH AND SOCIAL PROGRESS 



oppress others, all Greece rose to prevent this injustice; 
and yet today we suffer an unworthy Macedonian, a 
barbarian of a hated race, to destroy cities, celebrate the 
Pythian games, or have them celebrated by his slaves. 
And the Greeks look on without doing anything, just as 
one sees hail falling while he prays that it may not touch 
him. You let him increase his power without taking a 
step to stop it, each regarding it as so much time gained 
when he is destroying another, instead of working and 
planning for the safety of Greece, when everybody knows 
that the disaster will end with the inclusion of the most 
remote." 

An address of this kind would have been impossible 
in 490 B.C., when 10,000 Athenian citizen soldiers routed 
the much more numerous Persians at Marathon ; or even 
in 400 B.C. when 10,000 Greeks marched through the 
whole Persian empire and lost only 2,000 men within a 
year of constant fighting against treacherous enemies and 
hostile elements. In about 50 years the character of the 
Greeks had deteriorated sufficiently to call for the sharp 
rebuke of Demosthenes. 

(3) Is there any specific cause that may explain this 
result ? 

Modern times have witnessed the wholesale de- 
struction of many nature-peoples, e.g., the Caribbeans 
and the Indians. Their extinction was due not so much 
to the arms of the white men, as to the introduction of 
new diseases, which, although comparatively mild ordi- 
narily among the whites, assumed the character of a 
plague among people whose constitutions were unpre- 
pared for these particular forms of disease. 

" I have heard that not so long ago a third of the Andamanese 
Islanders were swept away by measles. Whole populations have 
disappeared before smallpox and syphilis; and I suspect that 



HEALTH AND ANCIENT GREECE 97 

tuberculosis has had a marked, but as yet undetermined, effect 
on the world's history." 3« 

Malaria is not considered a virulent disease in modem 
times, because we have a specific in cinchona. Among 
nature-peoples, it often proves very disastrous, especially 
when newly introduced. 

"A fever visitation about the year 1830 was officially esti- 
mated to have killed 70,000 Indians in California, while at about 
the same time a malarial fever epidemic in Oregon and on the 
Columbia river, ravaged the tribes of the region and practically 
exterminated those of Chinookan stock." ^^ 

Dr. G. Archdall Reid attributes the disappearance of 
most nature-peoples to the epidemic effect of diseases, 
introduced among them by civilized men, among whom 
they are endemic. The virulence of a disease among a 
people is in inverse ratio to its racial training for it.*® 

From the facts cited it is evident that diseases like 
malaria, which are newly introduced into a population are 
epidemic in character, and therefore virulent, causing 
great mortality. They become endemic in the course of 
time and, while not responsible for many deaths directly, 
gradually undermine vitality and produce degeneracy. 
It is necessary now to prove that these conditions existed 
in ancient Greece. 

(4) When was malaria introduced into Greece, or 

rather Athens? 

Modern Greece is exceedingly malarious; the per- 
centage of infected persons varies from almost zero in a 
few localities to almost 100 in others; in the Greek 
army the lowest percentage was 27.8 in 1902 and the 
highest 44.8 in 1898 during the decade 1896 to 1905.'» 

" Modern Greece is Intensely malarious. In the Copaic Plain, 
examined by me last year, I estimated that quite half the children 



ffni 



? , 



98 HEALTH AND SOCIAL PROGRESS 



i 



' 



were infected, even in June before the annual malaria season 
had commenced. The Attic Plain is, and probably always was, 
much healthier owing to its dry cHmate; but numbers of other 
plains and valleys are certainly as bad as the one I studied. 
The Grecian Anti-Malaria League has collected excellent sta- 
tistics on the subject, and these have been published by Drs. 
Savas, Cardamitis, and others. For instance it has been esti- 
mated that in the unhealthy year 1905, out of a total population 
of only about two and a half millions, nearly a miUion people 
were attacked with malaria, and nearly six thousand died. 
Blackwater fever, the worst form of malaria, is exceedingly 
common. I have never seen, even in India and Africa, villages 
more badly infected than Moulki and Skipou in the Copaic 
District. The Greek Army is as heavily infected as was the 
Indian Army until the last few years." *<> 

The malarious character of modem Greece does not, 
of course, prove that ancient Greece was likewise in- 
fected. Two conditions are necessary to make a coun- 
try malarious, the presence of mosquitos of the species 
anophelines, and the existence of malarial parasites in 
human beings. Without either of these conditions 
malaria is impossible. Sir Patrick Manson describes the 
introduction of this disease picturesquely. 

" Imagine an island in mid-ocean, far away from any malarial 
continent. It has its own special insect pests, mosquito among 
them, but there are no anopheles. Malaria therefore is un- 
known. On an evil day for the island a fast-steaming ship 
arrives and introduces— perhaps as larva in a water-tank, or 
in a neglected water-bottle in some unoccupied passenger cabin, 
or otherwise— the cursed insect. The hydraulic and climatic 
conditions are favorable and the anopheles multiply apace. 
Presently in some coolie laborer from India or China, or in 
some native returned from service in a foreign country, or in 
a sailor, or traveler, malarial gametes come on the scene. The 
anopheles, now numerous, become infected, the inhabitants get 
malaria, and the island, formerly noted for its salubrity, becomes 
a byword for unhealthiness. 



fi^F ' 



HEALTH AND ANCIENT GREECE 99 

This is no fancy picture. For centuries after its discovery 
and colonization Mauritius was noted for its beauty, its de- 
lightful climate, and for its salubrity. There were no anopheles 
there in the days of Paul and Virginia. Situated in the middle 
of the Indian Ocean, far away from continental influences, 
it enjoyed an equable climate well suited to recruit the broken- 
down, anxmic constitution of the victim of tropical disease. 
So high was its reputation for salubrity that up to the early 
sixties, in times when Europe was not so accessible as it is at 
the present day, it was used as a sanitarium by the British in 
India. Of course many of the invalid soldiers and civilians 
who visited the island and many of the imported Indians who 
labored on the extensive sugar plantations for which Mauritius 
was famous, must have introduced, since without number, mala- 
rial parasites. In those happier days, there being no anopheles 
present, any imported parasites did not spread, they died out. 
But about the time I mention, that is to say, in the early sixties, 
anopheles were introduced; how, is not known. Gradually 
they spread over the island, carrying the malarial germ with 
them. A big epidemic was the consequence, and now malaria 
is endemic in Mauritius, and large areas of this former sani- 
tarium are extremely unhealthy. 

" With the increasing opportunities of these modern days foi* 
rapid travel and communication, many islands and isolated dis- 
tricts at present healthy will at no distant date share the fate 
of Mauritius unless, before it is too late, effective measures are 
taken to prevent the introduction of anopheles." *^ 

The island of Mauritius proves that a definite date may 
be fixed for the introduction of this disease ; the specific 
year as given by Major Ross is 1866." Can an equally 
definite, or at least approximate, date be given for the 
entrance of malaria into Attica? Opinions are divided 
on this point. Deaderick seems to incline toward a belief 
of the early existence of the disease in Greece." Manson, 
too, is of that opinion, since " The history of malaria goes 
back to times of remotest antiquity. Already in the fifth 
century B.C., Hippocrates recognized the existence of 
periodic fevers, and divided them into quotidian, tertian. 



tt 



III 




1 



i 



Ill 



i^'l 



100 HEALTH AND SOCIAL PROGRESS 

sub-tertian, and quartan. Galen, Celsus, and other 
Roman writers also gave accurate descriptions of these 
fevers."** Jones, who has worked particularly on this 
problem, inclines toward the introduction of malaria into 
Athens about the year 425 b.c. But, suppose the disease 
had existed from early times ; that would not necessarily 
prevent good health of the Athenians, since the cases 
might be few and mild owing to particular circumstances. 
Major Ross argues this point as follows : 

"Suppose that the anophelines have been present from the 
first, but that the number of infected immigrants has been few. 
Then, possibly, some of these people have happened to take up 
abode in places where the mosquitos are rare, others may have 
recovered quickly; others may not have chanced to possess 
parasites in suitable stages when they were bitten. Thus the 
probability of their spreading the infection would be very small. 
Or, supposing even that some few new cases, infections, have 
been caused, yet by our rough calculations in section 12, unless 
the mosquitos are sufficiently numerous in the locality, the little 
epidemic may die out after a while ... for instance, during 
the cold season. And, if the number of infected persons intro- 
duced from outside remains small, this state of things may 
continue for years or centuries . . . the disease will fail to 
make headway and will die out. Now, suppose that the number 
of infected immigrants is suddenly greatly increased. Then 
much larger numbers of mosquitos will become infected, and 
may in their turn infect more healthy people than the recovery 
rate will compensate for. Endemic cases will begin, will in- 
crease; at first slowly, then rapidly, until suddenly there will 
be a widespread epidemic."** 

Mr. Jones bases his argument for the comparatively 
late introduction of malaria as a prevailing disease on 
four facts. L The absence of references to malaria by 
non-medical writers prior to 500 B.C., excepting two 
doubtful cases. One of these occurs in the Iliad, XXH. 
31 under th^ name of " f^ver," and ma^ be explained 



HEALTH AND ANCIENT GREECE 101 

by a reference to the coast of Asia Minor.*' The 
other is found in Theognis (550 B.C.), under the 
name of " ague." This may refer to Megara, where the 
poet lived as a supporter of the oligarchical party, or to 
Asia Minor.*^ H. On the increasingly frequent refer- 
ences to malaria by both medical and non-medical writers 
after 425 B.C. The first of these is made by Aristo- 
phanes in the Acharnians (425 B.C.), and the second in 
his Wasps (422 b.c.).*® Plato in the Timceus (between 
380-360 B.C.) speaks of quotidian, tertian, and the 
quartan fevers. Aristotle's works contain numerous 
references to malarial fevers. Hippocrates (born about 
460 B.C.), treats of malaria both in the Corpus, and in 
the Airs, Waters, Places, and gives the division of malaria 
quoted previously by Manson. HL The introduction of 
the cult of /Esculapius in 420 B.C. at Epidaurus, which, by 
the way, is very malarious today, having in some parts 
nearly 100 per cent of its population infected.*® This cer- 
tainly implies that ill-heahh was common. The suggestion 
that it was caused largely by malaria is strengthened by 
the frequency with which the votive offerings of the 
Greeks, after illness, took the form of a representation of 
the abdomen, since the malarial spleen, which not infre- 
quently reaches the weight of 70 or 80 ounces, over 
against 5 to 7 ounces for the normal, would be very 
noticeable, and the consequent enlargement of the ab- 
domen would certainly make a great impression on the 
non-medical mind.*® IV. The more numerous points of 
contact of the Athenians, both through war and com- 
merce, with other nations. They undertook the disastrous 
expedition into Egypt — one of the ancient malaria plague- 
spots — in 450 B.C. During the first Peloponnesian War 
(431-404 B.C.) their armies and navies were to be found 
in nearly every part of Greece and of the i^gean Sea. 



>; I 



102 HEALTH AND SOCIAL PROGRESS 



Hn 




I 



In 425, they were in the island of Sphacteria which, at 
least at present, is one of the worst malaria centers in 
the Mediterranean. From 415-413 they were at Syra- 
cuse, where this disease existed, and sickness and want 
caused them muCh distress. In 399 the Ten Thousand — 
reduced to 8,000 — returned after their march through 
many malaria infected parts of the Persian Empire. The 
case of Mauritius, cited above, illustrates how easily this 
disease may be introduced into a hitherto healthy com- 
munity, although the contacts with the outside world 
were not nearly as varied and numerous in this case as 
those of Athens during these fifty years. Hence the con- 
clusion that malaria was introduced into Athens during 
this period as a prevalent disease, seems very probable. 
Once introduced, it would have its baneful effects. 
General Gorgas also holds that Greece was free from 
malaria prior to 500 B.C. for reasons similar to those 
of Mr. Jones.* 

(5) How did malaria affect the Greeks? 

Under the first question a number of injurious effects 
from malaria were cited ; these may now be supplemented 
in the case of the Greeks. 

"The degradation of those who inhabit malarious places was 
carefully recorded by Hippocrates. He states that those who 
live in low, moist, hot districts, and drink the stagnant water, 
of necessity suffer from enlarged spleen. They are stunted 
and ill-shaped, fleshy and dark, bilious rather than phlegmatic. 
Their nature is to be cowardly and averse to hardship, but good 
discipline can improve their character in this respect"*^ 

Plato, in the TinuBus, declares " that the humors of 
acid and salt phlegms, and such as are bitter and bilious, 
when no outlet for them from the body can be found. 



* The Scientific Monthly, August, 1916, p. 133, 
and the Prevention of Malarial Fever." 



Ronald Ross 



HEALTH AND ANCIENT GREECE 103 



befog the soul and produce manifold vices — peevishness, 
melancholy, rashness, cowardice, forgetfulness, and stu- 
pidity." " 

Jones makes this statement about Greece after the 
fourth century before Christ: 




«« 



Gradually the Greeks lost their brilliance, which had been 
as the bright freshness of healthy youth. This is painfully 
obvious in their literature, if not in other forms of art. Their 
initiative vanished; they ceased to create and began to comment. 
Patriotism, with rare exceptions, became an empty name, for 
few had the high spirit and energy to translate into action 
man's duty to the state. Vacillation, indecision, fitful outbursts 
of unhealthy activity followed by cowardly depression, selfish 
cruelty, and criminal weakness, are characteristic of the public 
life of Greece from the struggle with Macedonia to the final 
conquest by the arms of Rome."** 

The children are the worst sufferers from malaria until 
at least the age of adolescence, when they become partially 
immtme. The effect which these repeated attacks of an 
everlasting and ubiquitous incubus must have on a people 
is well described by Ellett. 

" It would seem that this disease with its constant drain upon 
the resources of the growing body, must put a check upon the 
development, physical and mental, of each successive rising 
generation. Viewed from an entirely medical standpoint, the 
question can admit of no doubt. The succession of febrile 
attacks would alone be a serious tax upon the growing child; 
while the consequent anaemia, which so soon makes its appear- 
ance, must make the child incapable of prolonged application, 
and rob him to a large extent of his powers of mental recep- 
tivity. It is only too evident that in a few generations a type 
of man possessing extraordinary mental and physical powers, 
may become under this scourge of malaria greatly altered and 
debased. If it be that the malarial parasite was introduced 
into Greece during the fifth century b.c, it is quite possible 
for the disease, running a practically unchecked course, to have 





« 



li 

I 



104 HEALTH AND SOCIAL PROGRESS 

produced the profound deterioration which occurred in the 
Greek character during the next century and a half."** 

(6) Why were the effects so disastrous? 
The pernicious effects of a newly introduced disease 
have been explained previously under the third question. 
In the case of the Greeks there were special and addi- 
tional reasons why malaria should assume such a virulent 
character. The great plague of 429-427 b.c. was an 
indication that sanitary measures in Athens were inade- 
quate. These conditions were favorable for the breeding 
of mosquitos, and all that was needed was a number of 
infected persons coming from infected regions to spread 
the disease rapidly. During the Peloponnesian War, At- 
tica was invaded and laid waste almost constantly, and the 
country-people had to take refuge in the city ; food had 
to be imported from abroad. These facts brought about 
a crowding of the population, and a few infected persons 
would suffice to spread malaria quickly. This was espe- 
cially the case during the latter part of the war, when the 
Spartans had permanently occupied Decelea in 413 b.c, 
and the country people had to live not only in the Piraeus 
where they were constantly subjected to new infections, 
but between the long walls. The food supply must often 
have been scanty, and this may have been a predisposing 
factor to cause a greater virulence of the disease, since 
the power of resistance would be less. 

Another factor was the absence of a specific. Cinchona 
is absolutely necessary in the treatment of malaria ; and 
this was introduced into Europe in 1640. It was prized 
very highly, since Louis XIV, who was attacked with a 
rebellious and severe intermittent malarial fever in 1679 
and cured by Talbot with a concentrated vinous tincture 
of the bark, paid 48,000 pounds sterling for the secret and 
gave a life annuity of 2,000 pounds to Talbot." 



HEALTH AND ANCIENT GREECE 105 

The Greek peasant of today values quinine almost as 
much as his bread, and the government has formed a 
monopoly to insure its purity at a moderate price.*^* 

Without this specific the ancient Athenians had but 
little chance to combat the disease, since they did not 
apply the only other possible remedy— the draining of 
swamps and the elimination of small pools— sufficiently, 
because they, while being aware in a general way of the 
relation between malaria and swamps, had no idea of the 
role of the mosquito in the transmission of the disease. 
Hence they were not only in both these respects handi- 
capped, but also unable even to know what to do to 
fight the disease effectively. 



_^^ ^. 



I 




HEALTH AND ANCIENT ROME 



107 




I 



CHAPTER VII 

HEALTH AND ANCIENT ROME 

It is not as easy to fix the date of the introduction of 
malaria into Rome as it was in the case of Athens. 
Jones" gives the second Punic War (218-204 b.c.) as 
a possible date. Thomas Ashby, the Director of the 
British School of Archaeology at Rome seems inclined to 
an earlier date. 

"What had previously, it seems, been a well-peopled region, 
with peasant proprietors, kept heahhy by careful drainage, 
became in the fourth and third centuries b.c. a district consist- 
ing in large measure of huge estates (latifundia) owned by the 
Roman aristocracy, cultivated by gangs of slaves. This led to 
the disappearance of the agricultural population, to a decline in 
public safety, and to the spread of malaria in many parts; 
indeed it is quite possible that it was not introduced into Latium 
before the fourth century b.c. The evil increased in the later 
period of the Republic, and many of the old towns of Latium 
sunk into a very decayed condition . . . Cicero speaks of 
Gabii and Fidenae as mere 'deserted villages,' and Strabo as 
*once fortified towns, but n6w villages, belonging to private 
individuals.' Many of the smaller places mentioned in the list 
of Dionysius, or the early wars of the Romans, had altogether 
ceased to exist, but the statement of Pliny that fifty-three com- 
munities ipopuH) had thus perished within the boundaries of 
Old Latium is perhaps exaggerated. By the end of the Re- 
public a good many parts of Latium were infected, and Rome 
itself was highly malarious in the warm months." ** 

Evidence from contemporary writers is, however, suf- 
ficiently plain to make the existence of malaria cerUin. 

io6 



Plautus (died 184 b.c.) in the Curculio refers to it with 
the question : Did a fever leave you yesterday or the day 
before? And Terence (died 159 b.c.) refers to quo- 
tidian fever in the Hecyra. M. Porcius Cato (died 149 
B.C.) has left a treatise " on agriculture " and speaks in 
Chapter CLVII of what to do " In cases of black bile 
and swollen spleen." The conjunction of black bile and 
enlarged spleen are fairly clear symptoms of malarial 
cachexia. 

"From Cato to Cicero (106-43 b.c.) is a long interval, and 
one which has left us but a few fragments of literature. It 
may, however, be noticed that Q. Fabius Maximus, who was 
consul in ac. 121, suffered from malaria, if we may trust the 
story told by the Elder Pliny. But in Cicero is found frequent 
mention of tertians and quartans, and his contemporary, Varro 
(118-29 B.C.) declares that in marshy places 'crescunt animalia 
quaedam minuta, quae non possunt oculi consequi,' and that 
these minute creatures, entering the body by the mouth and 
nostrils, produce 'difficiles morbos.' From the time of Cicero 
most writers mention malaria in unmistakable language, and 
it certainly had become, by the Christian Era, a disease with 
which the Romans were perfectly familiar. The physician 
Celsus (about 50 a.d.) almost confines his discussion of fevers 
to the intermittents, so that in his book, febris is practically 
equivalent to malaria."** 

The prevalence as well as the existence of malaria in 
ancient Latium is, then, an indubitable fact. Even if it 
existed there prior to 2(X) B.C., there are many features 
in Roman history, which point to an accentuation of the 
disease after that time. Rome commenced her permanent 
expansion beyond the borders of Italy with the second 
Punic War; she sent her armies into Africa, Carthage, 
Egypt, and various parts of Asia, and occupied Greece 
and Sicily. But all these countries were malarious; 
some of them were badly infected. The armies would 



!■ ■!(: 



1>A 



f 



i 



108 HEALTH AND SOCIAL PROGRESS 




return home with the disease, spread it, and in a short 
time it would become endemic. The prisoners, too, com- 
ing from many infested districts, would help in spreading 
the disease, especially in the country districts where many 
of them went as slaves. It was, perhaps, in this manner 
that the large estates of the Roman gentry became so 
thoroughly infected that many parts of Latium became 
uninhabitable. 

Economic and political causes assisted in the spread 
of malaria. The creation of the large estates brought 
many small landowners to Rome, where they helped in 
increasing the ranks of the plebeians. The result was 
that the city became constantly more congested, and the 
country districts depopulated. The colonists who were 
sent out into the newly conquered provinces were the 
more energetic and enterprising farmers, and that de- 
prived the country districts of the best elements. The 
remainder went to the city and increased the rabble in the 
metropolis. Without occupation and without regular means 
of support, these malaria-stricken people sank lower and 
lower still ; they became the followers of every demagogue 
who promised pattern et circenses, or rich booty from 
the slaughter of the patricians and the conquered peoples. 
In the course of time the upper classes were infected, and 
a general deterioration of Roman character commenced. 

A debased vitality is the only explanation of the atroci- 
ties of the continuous civil wars, of the butchering of 
conquered peoples during the first century B.C., the 
crucifixion of slaves for seeking even a semblance of 
human rights, and the shamelessness of the women at 
and around the court of the first emperors. 



" Every now and then the modem world is shocked by atroci- 
ties committed by white men in tropical regions. Humanity and 



HEALTH AND ANCIENT ROME 



109 



justice seem to be forgotten; civilization and education are 
powerless to prevent furious outbursts of savagery. How much 
of this is due to the baneful influence of malaria is known 
only to those who have an intimate acquaintance with the disease. 
Something of the same kind happened in Rome. Malaria made 
the Greek weak and inefficient; it turned the sterner Roman 
into a bloodthirsty brute. The terrible pictures of life in the 
first century a.d., as painted by Tacitus and Juvenal, show that 
Roman society was not only wicked but diseased. The extrava- 
gant cruelty, the wild desire for excitement, the absence of 
soberness and self-control, all point clearly to the same physical 
defect." •» 

A change in the fundamental characteristics of a people 
is much more serious than any other, and such a change 
is exactly what malaria will produce. Just because it is a 
disease only occasionally fatal when endemic, it is neg- 
lected, and exerts its harmful effects insidiously upon 
many individuals, and through them upon the life of 
society and of future generations by reason of poor 
heredity through lowered vitality. Continued through a 
number of generations, this process must bring about ex- 
tinction. A disease of this kind slowly saps the energy 
and vitality of a people, until there are none left to 
continue the struggle. For while other diseases, like the 
plague or acute attacks on single organs, brace a people 
by weeding out the unfit, a slow disease like malaria 
seizes all, fit and unfit alike, until a greatly depleted 
vitality must end in extermination. 

Note: Just as this manuscript was going into the printer's 
hand, a new book by Ellsworth Huntington, World Power and 
Evolution (New Haven, 1919). appeared. While its author 
tries to establish the climatic theory— to be discussed m Chap- 
ter X — as the chief cause of the rise and fall of nations, ho 
admits on pages 200 and 201 that malaria was a serious con- 
tributory factor in the change of the Roman character, accept- 
ing the theory first propounded by W. H. S. Jones. It is of 
interest to notice that he places the climatic change which started 
ti)« dedin« of Rome at »bout 22$ bx., which would coincide 



fi 



no HEALTH AND SOCIAL PROGRESS 

with Dr. Ashby's date and precede that of Jones by seven 
years. 

In discussing the backwardness of Turkey he likewise admits 
the importance of malaria as a cause and suggests the elimina- 
tion of it as a remedy (pp. 223-6). This seems to be incon- 
sistent with the climatic theory as the chief cause since climate 
is beyond our control, while malaria is not. 



i^HW 




CHAPTER VIII 

EFFECTS OF ILL HEALTH ON THE CLASSICAL 

WORLD 

The effects upon the classical world of this sapping of 
vitality are fairly clear, even though the argument be not 
strictly conclusive in every respect. There were certainly 
other factors which contributed to the downfall of Greece 
and Rome. These were, however, secondary rather than 
primary. For as long as a people preserves its vitality 
and abounds in health, it will not accept its doom at the 
hands of others without an attempt at resistance. It is 
the sick man who resigns himself to his fate ; it is the de- 
feated party that invents a theory to account for the 
result. The well man will struggle to preserve his ideals 
and his individual and political identity ; he will, if he 
philosophizes at all, think out a course of action to de- 
flect the blow and to avert the evil, and, perhaps, later, 
return thanks to the gods for his deliverance. 

It is only on the basis of a greatly depleted vitality 
and of greatly diminished numbers, that we can explain 
the attitude of the Greeks toward their misfortunes. To 
take up the last point first. 

The internecine conflicts of the Greek communities, 
the deadly struggles of the various factions in the ma- 
jority of the cities, and the numerous wars with foreign 
powers, had obliterated vast numbers of the old race of 
free citizens by the beginning of the Roman period. The 
extermination of the Plataeans by the Spartans and of the 
Melians by the Athenians during the Peloponnesian War, 

III 





ill 



m 



I 



112 HEALTH AND SOCIAL PROGRESS 

the proscription of Athenian citizens after the war and 
the massacre of the Corcyraean oligarchs by the demo- 
cratic party, the slaughter of the Theban^ by Alexander 
and of the Corinthians by Mummius, are only a few of 
the more familiar instances of the catastrophes which 
overtook the civic element in the Greek cities. Just 
how greatly the free citizens had diminished in numbers 
by the close of the first century after Christ, may be 
judged from the estimate of Plutarch that all Greece 
could not furnish more than 3,000 hoplites. All this must 
be admitted ; it is nevertheless not the true, at least, not 
the full explanation. The strife of factions in cities and 
internecine wars had existed before, and been perhaps 
more sanguinary, if we may judge from the razing of 
conquered cities ; yet the number of free citizens did not 
diminish, but rather increased from the time of Homer 
to that of Pericles, if comparisons of military strength 
are to be trusted. Homer credits the united Greek forces 
with 100,000 men; in 415 B.C., the Atheniani alone were 
able to send — after losing, according to Grote, 4,400 
hoplites in the plague of 430 B.C., and after sixteen 
years of almost continuous fighting in the Peloponnesian 
War — 36,000 men, including 5,100 hoplites to Syracuse, 
and reenforce this army with 5,000 hoplites two years 
later. This force was almost completely lost, yet Athens 
continued the struggle; and even after the slaughter of 
3,000 of her soldiers by Lysander in 405, she resisted 
Sparta for another six months, and only a few years later 
Xenophon had no difficulty in collecting 10,000 men for 
an expedition into Asia at the invitation of Cyrus. All 
these losses through war were heavy, but they are not 
the full explanation of the later submissive attitude of 
the Greeks toward their conquerors. 

We must, then, look for another cause to explain the 



*i 



ILL HEALTH AND THE CLASSICAL WORLD 113 



decay of Athens. A people that had blended the ideals 
of manhood and of national renown, and of national 
and personal integrity; that had produced the greatest 
number of famous men in every field within so short a 
time with such a small population; that had taught the 
lessons of restraint and imbued its members with a sense 
of willingness to surrender for the sake of these ideals 
so many opportunities and pleasures, according to the 
funeral oration of Pericles — a people, in short, that had 
conceived a clear ideal of what a man and a State ought 
to be and had proved its validity on many a battlefield, 
must have been healthy both physically and mentally. 
The average Athenian was joyous, but did not abandon 
himself to pleasure, because a healthy body enabled him 
to keep the balance which his philosophy taught him to 
constitute true manhood. This man knew how to com- 
bine action with contemplation; how to use the facts 
of life for enriching his personality and becoming a more 
useful citizen. He had leisure, but he used it for the 
State and not for self-indulgence. It was this combina- 
tion of a proper amount of action and contemplation, or 
of the Dionysian and Apollonian ideal as Nietzsche called 
it — each enriching the other — that gave the Athenian of 
Pericles* age the self-control and harmony, which en- 
abled him to become highly efficient in all lines both as an 
individual and a citizen. 

Yet, but a hundred years later the "Philippics" of 
Demosthenes went unheeded by the Athenians who were 
justly stigmatized as consisting in great measure of 
salaried paupers. They talked about what they were 
going to do, but preferred to dwell in contemplation of 
5ie glory of their ancestors. Apollo had completely re- 
placed Dionysius in the aflFections of the Greeks. 

Such a radical change could not have taken place 




i 





114 HEALTH AND SOCIAL PROGRESS 

within so short a time unless for physiological reasons. 
The policy of paying small salaries to the citizens to en- 
able them to give their time to public affairs, may have 
been instrimiental in producing a deterioration of char- 
acter. A healthy man will, however, render some service 
for such salary. The very fact that he is content to 
take something without rendering a quid pro quo is an 
indication that he is a pauper— sl physically and mentally 
diseased person who has lost his self-respect and is con- 
tent to live on the labor of others. It is evidently a case 
of physical degeneration. How was that brought about? 
Major Charles E. Woodruff has expounded an inter- 
esting theory in his book The Effects of Tropical Light 
on White Men. It is briefly stated as follows: Every 
animal and race of men has a zoological zone, in which 
they develop and prosper, but which they may not leave 
with impunity. The actinic or short rays of the sun- 
light destroy living protoplasm ; these short or violet rays 
are more numerous in strong or tropical light ; hence skin 
pigmentation was evolved for the purpose of excluding 
these rays. The zoological zone of the blonde, tall, long- 
headed type is northwestern Europe, chiefly Scandinavia, 
where the conditions were most favorable for its develop- 
ment — a dark, cold, severe climate. Coldness and severity 
taxed the ingenuity of the early inhabitants of these re- 
gions, and developed brain-power; the darkness and 
cloudiness made superfluous the development of pig- 
mentation. This highly intellectual people is responsible 
for all the civilizations from India to England, since it 
spread in every direction owing to the pressure of sus- 
tenance, and became the ruling class everywhere by sub- 
jecting the native races. But they could not survive in 
lower latitudes owing to the lack of pigmentation, and 
died out before they could acquire it. The ideas upon 



ILL HEALTH AND THE CLASSICAL WORLD 115 

which their civilization was based, survived, however, at 
least for a time; but soon became mere dead formulae 
in the hands of the darker indigenous peoples, and civili- 
zation decayed. The Greeks and the Romans were both 
of this stock, coming from the north at different times, 
and creating the respective civilizations on the basis of 
slavery. They were unable to acquire sufficient pigmenta- 
tion and became literally extinct, since the modern Greeks 
and Italians are, according to Major Woodruff, the de- 
scendants of the older, brunette type of man which was 
unable even to continue the civilization created for him 
by his fair-haired and blue-eyed northern masters. 

The problem of Greek and Roman degeneration would, 
according to this theory, be solved by complete extinction, 
owing to inevitable decay out of one's zoological zone. 
It would take too much time to criticise this theory in 
detail. Two questions only need be asked. Why was it, 
that Scandinavia, the original home of these peoples, was 
the last country in Europe to be reached by modern 
civilization, if this Scandinavian or Teutonic type 
of man was the only creative genius of mankind ? Again : 
how was it possible for this hardy race to survive the 
southern climate for at least a thousand years in Greece 
and about seven hundred years in Italy, and then sud- 
denly collapse within a century? For Major Woodruff 
places the earliest Teutonic migration about 2000 B.C., 
that of the Dorians about 1200 B.C.," and that of the 
Romans about 800 to 700 b.c.'^ That both people de- 
generated rather rapidly, the Greeks after 400 b.c. and 
the Romans after 200 B.C., seems to admit of little 
doubt after the proofs which have been furnished. Even 
admitting Woodruff's theory, there must have been an- 
other cause at work to explain the rapidity of degenera- 
tion, or perhaps extinction. 





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•11 



1 



116 HEALTH AND SOCIAL PROGRESS 

The introduction of a new disease, epidemic at first 
and then endemic, which gradually undermined the 
vitality of the people, seems to be the only explanation. 
Malaria has that effect and was introduced into Athens 
about 75 years before the decline of Greek character be- 
comes noticeable. If this theory is accepted, the decline 
of Greek civilization can be readily explained. 

Greek civilization was built on slavery. There was the 
numerically small but physically and mentally strong class 
of free Greeks, who devoted themselves to intellectual 
and warlike pursuits, and were of a superior race. This 
was evident from the fact that in Sparta the ruling class 
consisted of only about 9,000 families who held in check 
and exploited the Helots numbering about 200,000, and 
drew tribute from the Perioeci numbering about 120,000. 
A Spartan must, therefore, as a fighter, be as good as 
ten slaves. In Athens we have a similar situation. Dur- 
ing the time of Pericles there were in Attica about 90,000 
free-born Athenians, 300,000 slaves, and 40,000 Metics 
or resident foreigners who paid for the privilege of 
residence. A census taken in 309 b.c. by Demetrius of 
Phalerum gave the numbers as 21,000 citizens, 10,000 
Metics, and 400,000 slaves.* The significant feature in 
this change is the reduction in the number of Metics. 
What had become of them ? Had they departed with the 
decline of Athens, or had they replaced native Athenians ? 
The latter alternative seems the more probable, because 
the number of free Athenians had not changed appre- 
ciably, since 21,000 citizens in 309 b.c. is approximately 
equal to the 90,000 free-born population of the time of 
Pericles. The explanation may be found in the fact that 

♦The number of slaves cannot be ascertained definitely, since 
the state was not interested in them, but only in citizens and 
taxpaying Metics. Henct there are only estimates, which run 
all the way from the figures given to as low as 180,000. 



ILL HEALTH AND THE CLASSICAL WORLD 117. 

a larger number of Metics had received citizenship than 
was provided for by the reforms of Cleisthenes in 509 
B.C. Owing to the large mortality of Athenians in war 
and through disease, the number of citizens had become 
very small, and the depleted ranks could be filled only 
from the Metics and to some extent from the slaves. 
That means a considerable change in the constituency of 
citizens, although it need not surprise those who are 
accustomed to similar changes in New York, Boston, 
and Chicago through immigration. In each case an 
older population was supplanted by a new, and in the 
case of Athens, by an inferior, race. Whereas formerly 
citizenship was conferred only in rare cases on foreigners 
who were exceptional individuals, and the high standard 
of civic efficiency was thus maintained, the new situation 
called for naturalization on a large scale. The question 
is still to be answered, however, why the ranks of the 
native Athenians were depleted and not those of the 
Metics and slaves. Two answers should be given. 

The citizens were drawn into military service and 
suffered heavily during the numerous wars as has been 
indicated before. The Metics and slaves suffered hardly 
at all from this source. The more important factor is, 
however, that which concerns disease. The Metics were 
mostly Asiatics, and the slaves were mostly Asiatics or 
Africans and only to a small extent of Hellenic origin. 
The Asiatics and Africans came from regions where 
malaria had long been prevalent, and were at least to 
some extent immune ; they suflFered, consequently, much 
less from this disease than the native Athenians. A 
disease, as explained before, always causes more sickness 
and greater mortality in a population which is not accus- 
tomed to it. This is well illustrated in Mauritius, where 
malaria wa? responsible for 30,000 deaths in 1867 — out 



•j^ T-y 



118 HEALTH AND SOCIAL PROGRESS 

of a population of about 310,000 in 1861— -whereas 
cholera, a more mortal but more usual disease in that 
island, killed only 17,000 persons in 1854 in a slightly 
smaller population.*'* There is no record, of course, of a 
similar mortality in Athens, but the ravages of malaria 
must have been severe and the ultimate effects far- 
reaching, if one may judge from what is known about 
that disease. In order to fill up the depleted ranks of 
citizens, Athens became less discriminating in conferring 
citizenship and admitted many Metics and slaves to its 
rights. The citizens of the time of Demosthenes were, 
consequently, a largely non-Hellenic body ; or, if Hellenic, 
so weakened by malaria that they had lost the buoyancy 
and confidence which were such marked characteristics 
of their forbears. 

The situation about the third century B.C. was, con- 
sequently, very different from that of the end of the 
fifth. The citizens of Athens consisted largely of foreign, 
that is, of inferior stocks. The more energetic Greeks 
had emigrated to other parts along the Mediterranean 
where they spread their culture. It is remarkable that 
so many Greeks flocked to Alexandria in the third century 
and that this city became famous for its culture in so 
short a time. An explanation may, perhaps, be found in 
the fact that it was a healthy city and that Greek emi- 
grants found here a climate not too radically different 
from their own. For Strabo (63 B.C. to 24 a.d.) tells 
us that, notwithstanding its location, it was free from 
marsh-fever even in his time.** The radical change in the 
character of the population, brought about by disease, 
explains to a large extent the shallow productions of the 
later Greeks. Menander (342-291 B.C.) wrote not only 
immoral, but stupid and insipid plays. "If there be any 
moral lesson conve^^ed by the picture we have here of 



ILL HEALTH AND THE CLASSICAL WORLD 1 19 

Attic society, it is this: that the slave and the prostitute 
were not only more intelligent, but less immoral than their 
masters." •* This stricture would certainly apply more to 
Asiatics, such as the Athenians had largely become, than 
to the descendants of the victors of Marathon and Sala- 
mis. The Asiatics were the fittest to survive in this 
particular environment; but the best under conditions 
of this kind was but poor material. The crab apple 
lives and thrives in Siberia ; it is, however, a poor substi- 
tute for the luscious pippin of the Mohawk valley where 
the climate is better. The more serious Greeks were 
driven into anti-social philosophies at home, the more 
active men into mercenary service abroad, while the most 
energetic men had emigrated to Alexandria. A mob, 
recruited partly from the Metics and partly from the 
slaves, ruled Athens; and the follies and violences of 
stupid and corrupt demagogues were directly responsible 
for the disastrous conquest by Mummius. Small wonder, 
that this new type of Greeks was held in contempt by 
the Romans. It was a race of degenerates. It could not 
produce, so it began to comment. It could not originate, 
so it began to traffic in the knowledge of Plato and the 
poetry of Homer. The homines still lived but the znri 
were dead. 

The case was somewhat different with the Romans. 
They have always been more coarse, physically and 
mentally. Their decline was, therefore, less rapid, but 
not less certain. An important feature in their longer 
life as a nation was the larger extent of their country, and 
the consequent greater number of malaria-free spots. 
Greece has even today some of these. But they were 
of no help to the Athenian, since he could not leave his 
own little City-State without trespassing on foreign and 
hostile ground. Owing to the size of his country, the 



m 



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HBBw 
1 1 1131 



120 HEALTH AND SOCIAL PROGRESS 

Roman could go north and south; he could, in any case, 
go into the mountains and escape the most dangerous 
attacks of malaria. Thus the custom arose among the 
wealthy Romans of having villas in the Apennines, 
whither they would retreat during the summer and 
autumn. This was, however, only a temporary relief con- 
fined to the rich. The vast majority had to stay in the 
valleys and in Rome, where the air was not only hot and 
humid, but full of mosquitos, carrying the malaria para- 
sites from person to person. The infection soon produced 
its effect upon the Romans. They became a tainted and 
debased folk, penned up within the walls of the city. The 
average Roman deteriorated physically to such an extent, 
that, as Strabo tells us, the legions had to be recruited from 
Liguria because of the massive physique of these people.*' 
When these were infected and had deteriorated, the 
Romans looked beyond the borders of Italy, and Gauls, 
Spaniards, Istrians, and Germans were enrolled in the 
legions. A number of prominent men of letters were 
foreigners; during the first century a.d., there were, for 
instance, four Spaniards, Lucan, Martial, Seneca, and 
Quintilian. The foreign-bom emperors increased in 
number. This new blood from malaria-free countries, 
was infected in time, and every new infusion shared the 
same fate, till the Roman Empire fell to pieces. Again, 
as in Greece, there were other factors; but this disease 
was the original reason of Roman decay and gave fuller 
scope to other disintegrating factors. — The frequency 
with which German conquerors were attacked and killed 
by fevers in Italy during the Middle Ages needs merely 
to be mentioned here as a well-known fact. Time and 
again important events were decided by an attack of fever 
which either killed or caused the hasty removal of the 
leader to Germany. 



ILL HEALTH AND THE CLASSICAL WORLD 121 

The final result was that the builders of the Roman 
Empire either died out, or degenerated, and were replaced 
by foreigners. In subsequent centuries the population 
grouped itself chiefly with respect to its power of re- 
sistance to malaria. The southern parts were settled 
chiefly by the Mediterranean races which came from 
regions where malaria was endemic, and who were, owing 
to their partial immunity, able to maintain fair health in 
these highly infected regions. The northern parts— less 
infected — were settled chiefly by various Alpine races and 
to some extent by the Teutonic race, and were able to 
maintain good health. In between these were representa- 
tives of both races, health depending partly on the par- 
ticular locality, and partly on the degree of civilization. 
The point which these facts bring out is the necessity 
of good health, especially freedom from endemic diseases, 
for a progressive civilization. In the north of Italy, 
certain cities, e.g., Turin, Milan, Genoa, Venice, Bologna, 
Florence, and Pisa, have for centuries stood for art, 
science, literature, advanced agriculture, and manufac- 
ture. From here have come during the nineteenth cen- 
tury, the greatest Italians — Cavour from Turin, Gari- 
baldi from Nice, Mazzini from Genoa, and Victor Em- 
manuel from Savoy. 

Rome owes its importance largely to artificial factors, 
historical, administrative, and ecclesiastical ; it has, how- 
ever, become practically free from malaria owing to 
better drainage and sanitation, and to more efficient medi- 
cal supervision. Southern Italy is, as far as anything 
pertaining to progress is concerned, practically unknown. 
This backwardness may, of course, be due to racial 
factors. If so, it is the more important that these races 
should be liberated from the endemic diseases which 
have in all probability made them v/hat they are. 



iii 



122 HEALTH AND SOCIAL PROGRESS 



* 



The Greeks and the Romans degenerated through 
malaria. H more highly gifted races lose their creative 
power, or even their health through malaria, it is evident, 
that those who have always been subjected to its in- 
fluence, can never rise to the full power of either of those 
races. It is impossible that a race whose children are 
infected regularly every one or two years after birth, 
and are subjected to the drain of this insidious disease, 
its long succession of febrile attacks and constantly in- 
creasing anaemia, should develop well-balanced individ- 
uals. They may be immune to malaria after adolescence, 
but the drain on the growing body is, as a rule, too heavy 
to permit of full, buoyant, joyous health, which is needed 
for higher mental pursuits. A weakness, making the 
nervous system highly sensitive, will always remain; 
persons afflicted in this way may become very receptive, 
but they cannot become creative because there is not a 
sufficient surplus of vitality stored up. Only those who 
have closely watched or experienced the ravages of 
malaria can possibly know the lack of freedom from 
which the patients suffer. They vary constantly between 
elation and depression, hence are always under the sway 
of physiological conditions and emotions. They cannot 
be self -controlled, because they have no surplus energy; 
hence the particular feeling always controls, whether it is 
elating or depressing. It could indeed hardly be other- 
wise. When the system is constantly on the defensive, 
and is attempting, so to say, to fill in a bottomless hole, 
it cannot develop that surplus of vitality, so necessary for 
control by the whole organism. The chief function of 
such a system must be to stop leakage, and that means 
inability to develop poise and balance. In Plato's terms, 
the particular organs claim too much attention in propor- 
tion to the importance of their function. This is the 



ILL HEALTH AND THE CLASSICAL WORLD 123 

chief damage which malaria and other low fevers inflict 
upon the race and the individual, and consequently upon 
civilization ; since races, thus handicapped, can never be 
creative or progressive. 



t 



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HEALTH AND THE TROPICS 



125 



IkERI 



1^ ■■ 

I. 
•r 

i 

it 



CHAPTER IX 

HEALTH AND THE TROPICS 

After viewing the eflFects of malaria, particularly on the 
classical world, it will be necessary to consider another 
endemic disease in a larger field, — hookworm in the 
tropics and sub-tropics. This will enable us to get a better 
idea of the devastating effects of such a disease, since we 
can study them in a much larger field. 

The tropics have always been unhealthy, and the 
Germans have succinctly expressed this fact in the state- 
ment : " Unter Palmen wandelt niemand ungestraf t." 
Formerly these unhealthy conditions were attributed 
chiefly to the heat and, more recently, to the actinic rays 
of the sun.^^ Physicians, studying conditions on the spot, 
have found, however, that endemic diseases are chiefly 
responsible for the unsanitary character of the tropics. 
The hookworm is, in addition to malaria, one of these, 
and its discovery is one of the most important events not 
only in the annals of medicine but in the world at large. 

The hookworm disease (anchylostomiasis or unci- 
nariasis) has been definitely known as to symptoms for 
three centuries. As early as 1648 Piso spoke about it in 
Brazil, Father Labat in Guadeloupe, 1748, and Bryon Ed- 
wards in Jamaica, 1799. But not until 1838 were the 
worms foimd by Dubini in Milan and their connection 
with the disease suggested, although similar worms had 
been found in the badger by Goeze in 1782 and named 
hookworms or uncinaria by Froehlich in 1789. Since 
then the disease has been extensively studied by many 



physicians, among whom may be mentioned as the most 
prominent : von Siebold, 1845 ; Bilharz and Griesinger in 
Egypt, 1853; Wucherer, supported by Brazilian physi- 
cians in Bahia, 1866; Paletti and Maliverria in Italy, 
1877-78, also Grassi and Parona, 1877. In America the 
disease was referred to as early as 1808 by Joseph Pitt, 
and by J. L. Chabert in 1821, both of whom described the 
desire for dirt eating on the part of whites and blacks, 
although neither was aware of the hookworm. In 1834 
Geddings noticed similar symptoms in the anaemic and 
cachectic " sand-lappers " of Carolina. The dirt eaters 
of Florida were described by Little in 1845, and similar 
cases in Alabama by Sir Charles Lyall in 1849. James 
B. Duncan gave a fuller description of cases in Louisiana 
in 1849. None of these men were aware that they were 
dealing with an extensive disorder. 

In 1866 the worms were noticed by Dr. Joseph Leidy 
who thought they might infect man and cause anaemia. 
In 1891 Dolley called the attention of physicians to the 
fact that the disease was prevalent in the South, and 
other physicians reported several cases from 1894 to 
1901, notably Allen J. Smith in Galveston who studied 
the ova in 1901. On May 10, 1902, Dr. Charles Wardell 
Stiles discovered a new species of the worm, Uncinaria 
Americana or Necator Americanus. Major Bailey R. 
Ashford suspected and proved the disease in Porto Rico 
in November, 1899 and published, with Dr. Walter W. 
King, a report of 100 cases in American Medicine, Sept. 
5th and 12th, 1903. In 1904 a government commission 
was appointed for the study and treatment of the disease 
in Porto Rico. Meanwhile Looss, through investigations 
carried on in Cairo, Egypt, had proved in 1898 that the 
larvae penetrated the skin of human beings, and thus 
pathology and treatment were made much easier.^^ 



I 



u- 



126 HEALTH AND SOCIAL PROGRESS 

The range of this disease is very extensive. The in- 
fection is rather prevalent in a zone about 66 degrees 
wide, extending from parallel 36 degrees north to parallel 
30 degrees south ; it occurs less frequently in higher lati- 
tudes, the extremes being 51 degrees north, and nearly 
40 degrees south. Practically all countries lying within 
the zone of the 66 degrees mentioned, are heavily in- 
fected, while north and south of it cases are found chiefly 
among miners, for instance, in Hungary where 95 per 
cent of them were infected, or in Belgium where 10,000 
miners near Liege had the disease in 1903. The Rocke- 
feller Sanitary Commission received reports from 54 
foreign countries stating the presence of the disease ; in 
Wales, Germany, Netherlands, Belgium, France, and 
Spain, it is confined to miners and is found in few 
localities ; but in 46 countries the infection is general and 
widespread. The more important of these countries are : 
Egypt with about 90 per cent of hospital cases in Cairo 
due to hookworm and about 50 per cent general infec- 
tion among the laboring population ; Algeria, where there 
is a considerable amount, although the percentage is un- 
known ; and along the east and the west coast down to 
the Cape, in Uganda, Mombasa, Mozambique, Zanzibar, 
Madagascar, and Mauritius. In Cameroon 70 per cent 
of the population are infected. In the interior. Natal and 
other parts are seriously infected, although figures are 
not available. 

Asia has many seriously infected areas; in Ceylon 
about 90 per cent of the people suffer from the disease ; in 
India, between 60 and 80 per cent are infected ; in China, 
the infection is variously estimated from 25 per cent for 
the city population to 75 per cent for the country popula- 
tion. In Cochin China the disease is extremely prevalent, 
and in the Malay states at least 60 per cent of the people 



HEALTH AND THE TROPICS 127 

have hookworm. In Korea, about 70 per cent of the 
farmers and 50 per cent of the entire population suffer 
from the disease ; in Japan cases of hookworm are fre- 
quent, but of a mild character. Burmah, Siam, Borneo, 
and Java have numerous and severe cases ; according to 
some estimates the percentage in Java runs as high as 
90 per cent in some localities. In the Pacific the disease 
occurs in many islands, on Samoa 70 per cent are suffer- 
ing. In the Straits Settlements about 10 per cent, and 
on the island of Sumatra as high as 95 per cent have 
hookworm. In Australia the disease is found chiefly 
in the Johnstone River district of Queensland, where in 
one school 90 per cent of the children were infected. 

Going over to South America, Argentina has but few 
cases ; in Paraguay they become more numerous ; and in 
Brazil hookworm is exceedingly prevalent. In the 
Guianas the estimate of the infected is about 50 per cent 
of the population. In British Honduras the percentage 
runs as high as 70. The Central American republics are 
severe sufferers from the disease— Panama, for instance, 
having 20 per cent of infected people. Concerning 
Colombia, the Rockefeller Commission reports as follows : 

" In general, it may be stated that, with the exception of that 
portion of Colombia situated at a greater altitude than 3,000 
feet, the entire country is infected with hookworm, and that 
within the infected areas about 90 per cent of the inhabitants are 
victims of the pest." «» 

In Mexico the disease is very prevalent, especially in 
the mining districts. 

Coming to the United States and its outlying terri- 
tories, we find that the Philippine Islands are seriously 
infected, the percentages in different provinces varying 
from 15 to 74 of the population. Porto Rico with a 



17 






128 HEALTH AND SOCIAL PROGRESS 

population of about one million in 1904 had about 800,000 
cases, while among the workers on the coffee planta- 
tions, the infection runs about 90 per cent. In Con- 
tinental United States, all the states from Virginia to 
Florida and Texas, and as far west as California, are 
sufferers from this disease, particularly Alabama, Arkan- 
sas, Georgia, Louisiana, Mississippi, North and South 
Carolina, Tennessee, and Virginia ; but cases are found 
in Kentucky, and other states along the Mississippi River. 
The 46 foreign countries in which the infection is 
widespread, comprise 14,464,158 square miles, with 919,- 
858,243 people. To this should be added 1 1 of our own 
states with an area of 510,149 square miles and a popula- 
tion of 20,785,777. This means that about 940,000,000 
out of the 1,600,000,000 people on the globe live in 
countries where hookworm disease is prevalent.^* These 
figures are, perhaps, too high; but even if they should 
prove to be somewhat lower, they would, nevertheless, 
be sufficiently high to act as a serious menace to the 
inhabitants of those countries, especially since in most 
of them, malaria is likewise very prevalent. These people 
live and multiply, but they lead miserable lives, and are 
unable to develop high vitality and fine brains. 

The physical effects of hookworm disease are both 
numerous and serious. In moderate infections a lower- 
ing of physical and mental strength occurs. School chil- 
dren are seriously retarded by the disease, and are 
rarely able to accomplish more than 60 per cent of the 
required work. 

"The worst cases are those in which there is a heavy infec- 
tion. . . . Even well-to-do subjects become severely infected, 
but among the underfed the results are most serious. Either 
the patient becomes rapidly anaemic with digestive disorders, 
sometimes severe diarrhoea with hemorrhages, anasarca [dropsy ][ 



HEALTH AND THE TROPICS 



129 



and extreme debility, or the conditions may be more chronic. 
Indolence and weakness lead to careless habits, reinfection 
occurs from time to time, often the whole family becomes 
affected more or less seriously." '^ 

Dr. Charles W. Stiles says: 

"The injury to patients results from the following factors, 
(l) Sucking of blood by the parasites, which is a constant 
drain on the system; (2) Loss of blood into the intestines 
through the minute wounds made by the parasites, the factor 
which also tends to deplete the system; (3) The wounds form 
points of attack for bacteria, hence increase of the chance of 
bacterial infection as well as toxic infection from poorly digested 
and decomposed food; (4) The wall of the duodenum and 
jejunum becomes thickened and degenerated, and its function 
is thus decidedly interfered with; (5) The parasite in all prob- 
ability produces a poisonous substance which acts upon the 
patient." " 

The drain upon the system is so severe in many in- 
stances that in cases of long standing, the patient is un- 
developed physically and mentally. Physical growth may 
be retarded to such an extent that a boy or girl between 
the ages of 12 to 14 may present the appearance of a 
child 6 to 8 ; even young men or women of 18 to 22 years 
old may have the development of children from 12 to 
16 years ; and the appearance may be either childlike or 
senile, especially like that of elderly dwarfs. The re- 
productive powers are seriously interfered with and their 
development is very much delayed, especially in the case 

of women. 

The mental effects are naturally more serious. Dr. 

Ashf ord says : 

" Over all the various symptoms with which the unfortunate 
jibaro (peon) infected by uncinaria, is plagued, hangs a pall of 
drowsy intellect, of a mind that has received a stunning blow. 
There is, to us, no one symptom at once so characteristic and 



i 



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I '1 




1^1 



130 HEALTH AND SOCIAL PROGRESS 

so pitiable. A benumbing influence seems to be exerted on the 
mental faculties, even before anemia and heart changes arc 
noted. There is a hypochondriacal, melancholy, hopeless ex- 
pression, which in severe cases deepens to apparent dense stu- 
pidity, with indiflference to surroundings and lack of ambition." »» 

In some cases the disease leads to insanity ; in many, 
for instance in Australia, a prevalent craving for dirt 
eating and severe moral degeneration is reported.^* 

The moral effects of hookworm disease are more seri- 
ous still, although less easily pointed out. Not much 
can be expected of a people whose vitality is so low 
that it averages only 40 per cent of hemoglobin and runs 
m some cases as low as 8 per cent, whose red blood cells 
number less than 2,000,000 in many cases, and in a few 
even less than 1,000,000, instead of the normal 5,000,000 
per cubic millimeter. There is a vicious circle of disease, 
mefficiency, and poverty ; a lack of ambition and of buoy- 
ancy. The patient has only one intense desire— that of 
deliverance. Unable to help himself, he turns eagerly to 
anyone or anything promising relief. He loses his feel- 
mg of independence and responsibility, simply because 
he IS unable to locate and cure this trouble, and his 
mind is filled with the wildest fancies. Under these con- 
ditions he falls an easy prey to " medicine men," charla- 
tans, patent cure-alls, and old women who pose as medical 
oracles and whose ignorance is exceeded only by their 
temerity. He is subject to all kinds of superstitions— 
the more weird and grotesque, the more acceptable. 
Witchcraft and voodooism are the natural product of 
such an unregulated imagination. Lack of control is a 
characteristic of the hookworm victims, and any stimulus 
from within or without is acted upon unrestrainedly. 
Mentally and morally he rarely passes the stage of the 
moron. The vegetative, self-preservative, and reproduc- 



HEALTH AND THE TROPICS 



131 



tive fimctions are the only ones which have any interest 

for him. 

The economic effects are more readily and accurately 
gaged. One illustration will, perhaps, best serve the 
purpose. California has only light infections, yet Dr. 
Herbert Gunn, the special inspector for the State Board 
of Health, reports : 

"There is no question that the general efficiency of the men 
is noticeably impaired. At one mine, employing about 300 la- 
borers, it was stated that a reserve of about 25 men had to be 
available to replace those who, on account of sickness, did not 
appear for work. Quite a few of the men have to lay off every 
now and again to recuperate. Several who were unable to work 
stated that when they arrived in Jackson, they were perfectly 
strong and well. A large number of these men were encountered 
on the streets, some of them presenting marked degrees of 
anaemia. The greatest loss to mine operators is occasioned by 
the large number of those moderately affected. ... A loss 
of 20 per cent in efficiency of those infected would be a con- 
servative estimate. That would mean in Mine No. 2, for in- 
stance, where over 300 men are employed at an average of about 
$2.50 per day, and estimating the number of those infected as 
low as 50 per cent, a loss of over $20,000 a year." ^^ 

The general social effects of the disease are best de- 
scribed by Wickliffe Rose, the Administrative Secretary 
of the Rockefeller Commission. 

"The sharp contrast between heavily infected communities 
and communities practically free from infection affords the 
most striking illustration that I have seen of the physical, intel- 
lectual, moral, social, and economic results of hookworm disease 

on a community. 

" Such a contrast we saw near Dr. Fisher's home. Lying a 
few miles northeast from Emerton in Richmond County and 
extending over the border into Northumberland and Westmore- 
land Counties is a large scope of country which for generations 
has been inhabited by a people set apart by marked characteris- 



M 



ll 



132 HEALTH AND SOCIAL PROGRESS 

tics from the people surrounding them on every side. The 
people are called ' Forkemites,' . . . and for generations the 
name has been a byword. Lack of energy and thrift has brought 
to the Forkemites extreme poverty with the inevitable mental 
and moral results." ^« 

This quotation not only illustrates what havoc the 
disease may work, but shows that it alone is responsible 
for such results. These people live under the same 
climatic conditions, they belong to the same stock of 
Virginia, and are of the same faith as those who live 
nearby but are more fortunate in living in areas com- 
paratively free from uncinariasis. Just as in the case 
of malaria, so in that of this disease there are numerous 
" islands " which are free from the infection, owing to 
conditions of soil, water, and sanitary conditions estab- 
lished by the inhabitants. It will be necessary to estab- 
lish this point a little more firmly by details. 

Both the Rockefeller Commission and the Porto Rican 
Commission found a remarkable improvement in the 
people who had been cured. Dr. Fisher reports one 
school at Totus Key, Va., where 38 out of 40 children 
were infected. It was a hard school and could not keep 
its teachers. After a year's treatment the children had 
been transformed— those who were dull and listless were 
active and alert; and those who could not study, found 
joy in learning. Coming from anaemic parents, they were 
infected in infancy, and after being cured their cheeks 
showed the glow of health for the first time in their lives. 
The transformation also manifests itself by a new light 
in the eye, an elastic step, and a hopeful outlook on life. 
External conditions had not changed with these children, 
excepting that a few sanitary measures had been intro- 
duced into the school and community; the victims had 
b^en cured of the disease^ and this meant a tremendous 



HEALTH AND THE TROPICS 



133 



change. Or when we read of case after case in which 
dull, hopeless, anaemic, thriftless, illiterate people have 
been changed into bright, alert, active, and industrious 
persons during a few months— living in the same houses, 
on the same farms, without any changes except being 
cured of this disease— we must come to the conclusion 
that the only drawback from which they suffered was 
ill health." If the cases were not well attested by com- 
petent physicians and scientists, one would imagine that 
an advertisement of " a patent cure " was being read. 

These rapid changes in improvement have their obverse 
in rapid deterioration. The report of Dr. Gunn, quoted 
previously, states that several of the sick men were per- 
fectly strong before they entered the infected mines. Dr. 
Dock confirms this statement from his own observation. 

"If we were to select the strongest people in the country 
and place them in conditions under which these patients are now 
living it would be only a generation or two before even a race 
of athletes would be in the same condition as the people under 
discussion." '* 

We have here cases of rapid deterioration analogous 
to those discussed in previous chapters (6, 7, and 8) as 
due to malaria; and these cases furnish corroborative 
evidence for what may have happened to the Greeks 
and Romans after the introduction of malaria. 

In order to prove the disastrous effects of uncinariasis 
in a particular country— as we showed those of malaria 
in Greece and Rome— it may be best to select Porto 
Rico as an illustration, because the disease has been 
studied there extensively from its various aspects. The 
island has an area of 3,606 square miles, with a popula- 
tion of about 1,120,000. The chief products are sugar, 
tobacco, coffee, and fruit. There is litUe manufacturing. 



i 



ii 



134 HEALTH AND SOCIAL PROGRESS 

and about 75 per cent of the labor is agricultural. This 
means that the welfare of the whole island is largely 
dependent on the labor capacity of those engaged in 
tilling the soil, that is, on the health of the jibaro or 
peon. Formerly coffee was the principal crop, having 
a value of $7,492,453 in American gold in 1897; sugar 
in that year was valued at $2,456,898, and tobacco at 
$732,117. In 1910 the values had changed to $23,545,922 
for sugar, $5,664,128 for tobacco, and $5,669,602 for 
coffee. During the years 1895-97 the coffee crop 
formed 70 per cent of the value of all exports, in 1910 
it had dropped to about 14.5 per cent. Whence this 
change? A few words on hookworm disease will be 
sufficient to explain it. 

The disease seems to have been introduced from Africa 
with the slaves about 1530, since Columbus reported of 
the original inhabitants that they possessed fine stature, 
and were " people of beautiful presence." ^* In all later 
reports the common white people are characterized as 
lazy, and indifferent to all improvements. In a descrip- 
tion of Porto Rico in 1834 we read : 

" Most of these colonists arc inconceivably lazy and indiffer- 
ent. Lying back in their hammocks, the entire day is passed 
praying or smoking. Their children, isolated from the city, 
without education, live in social equality with the young negroes 
of both sexes, acquiring perverted customs, only later to become 
cruel with their slaves." «<* 

But the more accurate observers state that these people 
were anaemic with a dead white, yellow, or greenish hue ; 
that the negroes and mestizos, when sick, were of an 
ashen gray color. These descriptions fit those suffering 
from uncinariasis, both as to complexion and supposed 
moral turpitude. The latter was, of course, nothing but 



HEALTH AND THE TROPICS 



135 



the result of physical lassitude and low vitality, owing 
either to hookworm, malaria, or to both. Writers of 
former centuries in describing the whites in the tropics 
and sub-tropics laid the blame for this lassitude on moral 
grounds, because they did not know enough about the 
effects of endemic diseases upon the body. Dr. Ashford 
refutes this charge in these words : 

" We cannot believe that vicious idleness comes natural to the 
Spanish colonist, even in the tropics, for the very reason that 
we have seen these descendants at their very worst, after the 
neglect of four centuries of their mother country and after 
the laborious increase of an ansemic population in the face of a 
deadly disease, whose nature was neither known nor studied, 
work from sunrise to sunset and seek medical attention, not 
because they felt sick, but because they could no longer work." *>^ 

These men were sick and could not work, and this fact 
explains the change in the decline of coffee values. 

Coffee is usually planted on small farms on the hill- 
sides, and requires much shade and moisture — ^thus af- 
fording ideal breeding-grounds for the parasites of this 
disease. Sugar, on the other hand, requires a dry soil, 
sun-baked, and bereft of shade— a rather poor culture 
ground for hookworm. After the American occupation 
capitalists opened up large sugar plantations equipped 
with modern machinery, paid fair wages, provided better 
housing conditions, and introduced various sanitary 
measures among their laborers, who were chiefly negroes 
and relatively immune to uncinariasis. Under these 
conditions the sugar crop increased rapidly, while that 
of coffee decreased because the laborers were not so 
well protected. That is, however, not the whole story. 
The coffee planters are much more numerous, and are 
the most exposed to the hookworm disease. Sugar and 
tobacco can be planted only in the coast regions, and by 



136 HEALTH AND SOCIAL PROGRESS 

far the larger part of Porto Rico must be given up to 
coffee. Thus the majority of the population is exposed 
to the dangers of the hookworm disease. 

"The picking of coffee is all too frequently done in the 
pouring rain, for the harvest coincides, as we have seen before, 
with the wet weather. The vast majority of the pickers now] 
and all before the campaign against anaemia began, are bare- 
footed. They work from a little after dawn to near dark, 
and are thus employed for about three months, the number of 
almudes picked getting scarcer as the ripened berries are gath- 
ered in. These plantations are heavily shaded, indeed doubly 
so, for the coffee bush, itself affording a dense shade, is further 
shaded by light guavas or trees about the size of a maple. Here 
in this shade the sopping wet ground is befouled by the multi- 
tude of sick each day, and the ripening ova give rise to an 
infinity of nests of active larvae into which several days there- 
after the same or other workers must tread. The result is that 
uncinariasis has its great breeding place in the coffee plantations 
of Porto Rico, and here a barefooted people pollute the soil 
and are infected and reinfected by it until the life of every 
man, woman, and child is punctuated by a vast number of re- 
infections, casual yet common in the nine months of ordinary 
work, certain and continuous during the coffee harvest when 
no worker escapes who is without shoes. Therefore it is small 
wonder, with constantly arriving reinforcements to the little 
army of parasites that thrive at the expense of the laborer, 
that we find a sick workingman in the country." ** 

Previous to the American occupation a still larger 
percentage than at present were engaged in coffee grow- 
ing, and the infection was correspondingly more preva- 
lent. How much this disease must have affected the 
condition of the Porto Ricans we can only surmise when 
we read that " It cripples industrial effort, limits mental 
expansion, weakens the body and depresses the spirit, 
until many laborers in a country where agriculture is the 
chief source of revenue, are enervated, despondent, with- 



HEALTH AND THE TROPICS 



137 



out hope of betterment, and without the power to save 
themselves. Sometimes a man cannot earn enough to 
feed his family, and he is driven to eat the crudest gifts 
of a bountiful nature in the wild fruits of Porto Rico." ^' 
It cuts down man, woman, and child of every age, and 
causes diminution in earning capacity of 50 per cent or 
even more. In light cases, having over 60 per cent hemo- 
globin, a previously vigorous individual finds his strength 
and energy waning, becomes dyspeptic, disinclined to 
work, and generally " run down," and has a faint pallor. 
In moderate cases, averaging between 30 and 60 per cent 
of hemoglobin, the individual becomes anaemic, with low 
mental and physical activity. The patient looks and 
feels definitely sick. Mere disinclination to work has 
changed to partial inability, since any exertion brings on 
palpitation of the heart, and sudden changes of position 
cause dizziness. He is pale and half narcotized. In in- 
tense cases, with hemoglobin below 30 per cent, the 
patient has dilation of the heart, extreme pallor, and a 
fatal termination of the disease may occur at any time. 
When we remember that the population of this island 
was about 1,000,000 in 1904, that about 800,000 of these 
were estimated to be infected, and that the infection 
wouli run as high as 90 per cent on the coffee planta- 
tions, we must conclude that no high state of mental, 
moral, and social conditions was possible with people 
who suffered from a disease, the symptoms of which have 
just been described, especially if we find that about 30 
per cent of the cases coming under the observation of 
physicians were " intense," 45 per cent " moderate," and 
only 25 per cent " light." 

Hookworm is, however, not the only curse of this 
island. Porto Rico has also suffered from malaria. No 
definite figures are available in regard to this disease, as 



138 HEALTH AND SOCIAL PROGRESS 

they are for uncinariasis, which was made a matter of 
several special reports. The " Report of the Governor 
of Porto Rico for 1913 " contains, however, some signifi- 
cant figures, which will enable us to draw some con- 
clusions in regard to the prevalence of malaria. On page 
113, about 60 per cent of all deaths are listed as possibly 
due to malaria. This is certainly an exaggeration, since 
out of the total number of deaths, (26,034 during the 
fiscal year 1913) all cases of diarrhoea and enteritis 
claimed 5,372, tuberculosis of the lungs 1,536, hookworm 
1,347, i.e., anchylostomiasis 383 and anaemia chlorosis 964, 
and malaria 1,073.®* This comparatively small number of 
deaths does not, however, argue a rare occurrence of 
malaria, since Colonel Gorgas explains the infrequency 
of deaths from this cause as perfectly compatible with its 
prevalence. He says: 

"The best measure of the working efficiency of a force, as 
far as health is concerned, is the daily number of sick. For 
instance, in a force such as we have at present, we might have 
1,500 cases of pneumonia, which would average ten days each 
in hospital, and give us 500 deaths. Fifteen hundred cases of 
malaria would average seven days in hospital, and give us not 
more than thirty deaths. The deaths from malaria, therefore, 
represent a very much larger nonefficiency from disease than 
do the deaths from pneumonia. Two deaths from malaria 
would mean that 100 men had been sick for seven days; that 
is, that 700 days had been lost from malaria during the year. 
Two deaths from pneumonia would only mean that 6 men had 
been sick for ten days, and, therefore, represent only sixty days 
lost from pneumonia." ** 

The 1,073 deaths attributed to malaria would on this 
basis represent at least 53,650 cases of seven days* dura- 
tion. This is, of course, too low a figure, since Colonel 
Gorgas argues from conditions as they exist in the Canal 
Zone where the employees are carefully watched and 



HEALTH AND THE TROPICS 



139 



instantly taken to the hospital when they show any symp- 
toms of disease. In the larger part of Porto Rico, that 
is impossible, owing to the scarcity of properly trained 
physicians ; and many cases of malaria are not diagnosed 
correctly so that the cases linger on for weeks and 
months, and deaths are attributed to other causes. It 
seems therefore safe at least to double the number of 
cases of malaria in this island, and to sextuple the number 
of days of illness. This would give approximately one 
malaria case in ten of the inhabitants, and a loss of 42 
working days per patient. That would give us with a 
population of over a million at a conservative estimate 
100,000 cases of malaria with a loss of 4,200,000 working 
days per year. The small number of deaths from 
malaria during 1913 is, however, only a part of those 
which occurred previous to the sanitary work which 
was inaugurated after the American occupation, since 
very little was done in a scientific way to combat the 
disease. Just how many cases there were, it is impos- 
sible even to estimate, as, due to the illiteracy of 80 
per cent of the people and to the scarcity of competent 
physicians, no accurate records could be kept. That 
there was much sickness and mortality is certain, as may 
be shown from the retardation of increase in the popula- 
tion after 1765 to 1775, when the decennial rate of in- 
crease was 57 per cent, which dropped to 16 per cent in 
1887-89, and rose only to 17.3 per cent from 1899- 
1910, notwithstanding the great work of sanitation and 
medical supervision introduced by the government during 
the latter part of this period. This increase has taken 
place in the face of a very high death rate in a dense 
population— approximately 300 to the square mile. The 
year 1899 may serve as an example of these high rates, 
because the birth rate exceeded a death rate of 40 per 



140 HEALTH AND SOCIAL PROGRESS 

1,000. Another fact points likewise in the direction of a 
decreased vitality. The population of this island below 
10 years of age has a percentage of 30.9, a greater per- 
centage than that of any civilized country, e.g., 22.2 per 
cent in the United States; yet in the latter country 13.8 
per cent are 50 years of age or over, against 9 per cent 
in Porto Rico. The decreased birth rate and the shorter 
span of life point toward lowered vitality — a condition 
which could not be overcome by the various ameliora- 
tive and preventive efforts of the government in a few 
years. The enormous number of deaths from tuberculo- 
sis and from diarrhoea, as well as the 13,441 deaths from 
all diseases of those under age in a total mortality of 
26,034 merely corroborates this statement, since low 
vitality alone can explain such mortality. Even if we 
should take the lowest estimate of 300,000 for those who 
suffer from uncinariasis, and figure only 100,000 for 
malaria patients, we are nevertheless face to face with a 
serious condition, since we have over one-third of the 
population ill as the effect of two diseases ; the other 
diseases combined would add at least 17, and this would 
make at least 50 per cent of the total population patients 
more or less constantly ill as against about 4 per cent of 
permanent sickness in the United States. 

The relation of malaria and uncinariasis is interesting 
from another point of view. The former attacks princi- 
pally children before and up to the age of puberty, and 
then gradually releases its hold ; the latter attacks chil- 
dren comparatively seldom, but is most virulent after 
puberty. Out of a total of 29,219 patients treated for 
hookworm in 1906-07 we have 1.09 per cent less than 5 
years of age; 8.90 per cent from 5 to 9; 20.80 per cent 
from 10 to 14; 37.45 per cent from 15 to 29; 24.15 per 
cent from 30 to 49; 7.49 per cent over 50." It seems, 



HEALTH AND THE TROPICS 141 

therefore, that no sooner does the jibaro get over the 
age when Scylla threatens his life, than Charybdis is 
almost sure to attack and kill him. 

In this brief discussion of the case of Porto Rico 
stress has been laid on hookworm disease, with a briet 
mention of malaria. There was no intention of claiming 
Xse to be the only diseases in the island, but simply 
the endeavor to show that of the 152 diseases enumerated 
as the causes of one or more deaths, these two were 
responsible for a high percentage, and were the pre- 
disposing cause of many more by depleting and devitahz- 
ing the body. Tuberculosis of the lungs and diarrhoea 
with enteritis were mentioned as the cause of more deaths 
than malaria and uncinariasis; neither of these diseases, 
however, kill people in vigorous health, but more usually 
those with low vitality. Malaria and uncinariasis under- 
mine the constitution, and thus predispose toward other 
diseases. They are responsible, moreover, for that low 
mentality, small initiative, and lack of ambition, which 
are reported by observers. This should cause sma 1 sur- 
prise if the meaning of health (see chapter two) con- 
sists essentially in a natural and irresistible desire for 
activity owing to surplus vitality. Healthy men can 
strive, plan, devise ways and means to improve their 
condition; ill men are content to leave things as they are, 
because they have no energy to spare for the new exer- 
tion required for experiments. Their principal desire 
is for relief ; and the whole attitude of mind becomes 
plaintive, passive, and negative. The inevitable result is a 
static civilization. 



CHAPTER X 

HEALTH AND WORLIXPROGRESS 

The facts brought out in the last chapter have a signifi- 
cance which cannot be over-estimated. For what is true 
concerning Porto Rico applies to the tropics and sub- 
tropics, and, if malaria be included, to a very much wider 
area — indeed to the larger part of the temperate zone. 
If the facts as to disease and its bearings have been cor- 
rectly explained, they ought to elucidate conditions as to 
progress in the past, and to throw some light on the 
future movements of mankind. An attempt will be made 
in this chapter to explain some of these problems. 

I. THEORIES ADVANCED TO ACCOUNT FOR PROGRESS 

Explanations of the progress of man from the stage 
of his primitive ancestors may be roughly divided into five 
classes. 

1, the transcendental; 2, the historical or accidental; 
3, the natural or geographical; 4, the anthropological; 
5, the actinic ray theory of Major Woodruff. 

1. The transcendental theories of various kinds, e.g., 
the mythological, theological, and philosophical, which 
have determined the thinking of past ages until recent 
times, are, of course, unscientific. The philosophy which 
looked upon Cyrus the Great as the executive of Jehovah 
to punish disobedient people, is no more taken seriously 
as an explanation of the movement of mankind toward 
a certain goal, e.g., of universal peace, than are the de- 
feats and victories of Israel as results of disobedience 

24a 



HEALTH AND WORLD-PROGRESS 143 

or of obedience, respectively, to Jehovah. This view has 
dominated the whole of Christendom, and whether true 
or not is not open to objective proof. The so-called 
" principle of the dialectics of history " propounded by 
Hegel is not more satisfactory from a scientific point 
of view " Reason is the innermost substance of history, 
which is logic in action."-" The victorious State is truer, 
nearer to the ideal State, better, in a word, than the 
vanquished State. The very fact that it has triumphed 
proves this; its triumph is the condemnation of the 
principle represented by the vanquished ; it is the judg- 
ment of God. Thus interpreted, history resembles a 
series of divine reprisals directed against everything that 
is finite, one-sided, and incomplete ; it^ is an eternal dies 
ir(B, which nothing earthly can escape." " , , 

All that needs to be done by a nation in order to be 
successful is to become a true embodiment of the State- 
Idea and it becomes that in proportion as it defeats its 
enemies, since its victories are a perpetual proof of its 
approach to the true purpose of the world-spirit. 1 his 
brings us back to the theory of Aristotle that victorious 
people always represent more virtue than the vanqmshed. 
Neither of these philosophers tells us, though, why one 
conqueror has approximated the true idea of the State 
more than another, except that the God of history has 
successively chosen the Egyptians, Assyrians, Greeks, 
Romans, French, and the Germans as temporary and 
privileged organs. Whether these respective nations were 
literally " chosen " and later on rejected as was Cyrus 
the Great, or whether they gradually evolved a truer idea 
of the State and then lost it, we are not told. Victory is 
the proof of superiority in ideas, defeat of inf erionty ; 
but why or how either victory or defeat can be thus ex- 
plained is an impenetrable mystery which the God of his- 






144 HEALTH AND SOCIAL PROGRESS 

tory has not chosen to reveal; and all we can do is to 
stand in awe and worship the Hegelian idol. 

2. The historical or accidental explanation of the 
progress of mankind does little more than put its seal on 
facts. Professor Boas claims that there is no essential 
difference in the ability of various peoples and that the 
earlier civilization of certain races was an accident. To 
quote his own conclusion: 

" Several races have developed a civilization of a type similar 
to the one from which our own had its origin. A number of 
favorable conditions facilitated the rapid spread of this civili- 
zation in Europe. Among these, common physical appearance, 
contiguity of habitat, and moderate differences in modes of 
manufacture, were the most potent. When, later on, civilization 
began to spread over the continents, the races with which 
modern civilization came in contact were not equally favorably 
situated. Striking differences of racial types, the preceding 
isolation which caused devastating epidemics in the newly dis- 
covered countries, and the greater advance in civilization, made 
assimilation much more difficult. The rapid dissemination of 
Europeans over the whole world destroyed all promising be- 
ginnings which had arisen in various regions. Thus no race 
except that of Eastern Asia was given a chance to develop an 
independent civilization. The spread of the European race 
cut short the growth of the existing independent germs without 
regard to the mental aptitude of the people among whom it 
was developing. On the other hand, we have seen that no great 
weight can be attributed to the earlier rise of civilization in the 
Old World, which is satisfactorily explained as a chance. In 
short, historical events appear to have been much more potent 
in leading races to civilization than their faculty, and it follows 
that achievements of races do not warrant us in assuming that 
one race is more highly gifted than the other. " ** 

If the earlier development of European civilization is 
an accident or a chance, no attempt at an explanation can 
or need be made, and we are where we were before — 



HEALTH AND WORLD-PROGRESS 145 

facts are facts and all that we can do is to accept them 
and put our seal of approval on them. This is what 
Hegel did, and found this world the best of all possible 

worlds. 1 . 

3 The natural or geographical theories try to explain 

the progress of certain races as a result of topography, 
climate, and other factors of nature. The Ratzel-Semple 
theory— the latest in this field— distinguishes four funda- 
mental eflfects. L direct physical effects of environment; 
n. psychical effects; HL economic and social effects; 
IV effects upon movements of people. 

(I ) Physical effects. Under this head are enumer- 
ated: stature, dominant activities, and pigmentation. 
After giving numerous examples under each sub-division, 
Miss Semple admits the inadequacy of geographical con- 
ditions to account in full for the effects cited: 

"The geographer must investigate the questions when and 
where deeper shades develop in the skins of fair races; wha 
h the significance of dark skins in the cold zones and of fair 
ones in hot zones. His answer must be based largely on the 
::: lusions of physiologists and physicists, and only when thes 
have reached a satisfactory solution of each detail of the prob 
lem can the geographer summarize ^he influence oenviro^ 
ment upon pigmentation. The rule can therefore safely be laid 
Town tL in all investigations of geographic influences upon 
the permanent physical characteristics of races the geogra^^^^^ 
distribution of these should be left out of consideration till the 
last, since it so easily misleads." «» 

It is not our purpose to explain the origin of pigment 
of the skin, but the physiologist referred to by Miss 
Semple might get some hint from the physician who in 
case after case describes the complexion of hookworm 
victims as " verv pale," '^ extreme pallor," or an " extreme 
pallor of a dirty, waxy color " ; or when we read that pel- 



' 



146 HEALTH AND SOCIAL PROGRESS 

lagra causes the skin to thicken and become pigmented. 
And so might the anthropologist in attempting to account 
for stature when he finds that these victims at 12 or 14 
years of age present the appearance of children of 6 to 
8; or young men and women of 18 to 22 that of children 
of 12 to 16 years. Or when he reads of brothers, one 
with light infection, 17 years of age, weight 156 pounds; 
the other with heavy infection, age 18, weight 74. Or 
when he finds that a boy of 16 years with very heavy 
infection and ill for 8 years, weighed 62>^ pounds on 
July 29, 1911, and 79 pounds on September 16, 1911— 
a change due solely to an improvement in his blood after 
the expulsion of the hookworms, since on August 3, his 
hemoglobin was 14 per cent and his red corpuscles num- 
bered 1,050,000; while on September 16, after the ex- 
pulsion of the last parasites on the 9th of that month, the 
figures stood 55 per cent and 4,572,000, respectively.'^ 

Definite facts like these should outweigh general theo- 
ries of what nature tends to do or what the influence 
of this or that hazy factor is supposed to do. For they 
should be taken in their full bearing. If certain endemic 
diseases have been acting for untold generations upon 
certain peoples, the effects become cumulative, and it 
may well be that an explanation of " the significance of 
dark skins in the cold zones and of fair ones in hot 
zones " can be found. Or if a people is habitually sub- 
ject to such a disease, the average stature must of neces- 
sity become low in the course of time through heredity. 
Illustrations of the effect upon complexion and stature 
of only one disease have just been given. Malaria has, 
however, similar effects. And it was shown in chapter 9 
that at the lowest estimates about 50 per cent of the 
people of Porto Rico were more or less constantly ill 
from the effects of these two diseases. There are others 



HEALTH AND WORLD-PROGRESS 147 

with even more disastrous results, e.g.. venereal; and 
new ones may be discovered, which, if local may account 
for many peculiarities now vaguely attributed to race 
or " climate." If the influence of food and occupat^^^^^^^ 
should, moreover, be studied by physiologists, a further 
explanktion could, perhaps, be made concerning these 

^(nTpsychical effects. Among the influences o! 
geography upon the mental life Miss Semple mentions 
Se direct and indirect; among the former chiefly the 
enrichment of the vocabul^y owing to local environment, 
e a of mountain, valley, river, sea, and dependent occu- 
pations, as the chase, herding, navigating and a broader 
effect upon the religion and mythology of peoples 
Among the indirect influences mentioned are the general 
STd of thought given to man's mind by the conditions 
which affect him as an active agent, challenge his will by 
furnishing motives for its exercise, give purpose and 
XTction to his activities-conditions which mold his 
mind and character through the media of economic and 

'"^AU Ih^s is sufficiently vague to be alluring, although 
Miss Semple does not see that richness of vocabulan^ 
is but another name for poverty in power of ^^^^^^ 
tion, since a more civilized man expresses the same ideas 
by qualifying adjectives and modifying adverbs mstead 
of having, for instance, four different terms ^or various 
k nds of mountain passes. She also overlooks the fact 
that this richness in vocabulary is due rather to occupa- 
tions than geographic conditions; e.g., the Samoyedes, 
who have ekven or twelve different terms to designa e 
the various grays and browns of their reindeer, are 
nomads. A golf or hockey player going to that country 
would most likely continue to use his vocabulary acqmred 




148 HEALTH AND SOCIAL PROGRESS 

in Scotland or America notwithstanding the difference 
in geography, and an engineer would continue using 
English, German, or French terms in his work and not 
trouble himself about the different words for grays and 
browns of reindeer. Occupation determines the mental 
life more than environment, as is well illustrated by the 
fact that the nation which excels in any one line of 
activity creates a vocabulary for the whole world, since 
language is only the outward form of ideas. We still 
think in terms of Greek philosophy, and try to cast our 
scientific terms in Greek or Latin vocabularies simply 
because these peoples excelled us in creating a rich 
treasure of words owing to their varied activities. France 
was preeminent in automobile manufacture, and the 
terms invented in that country in connection with all that 
this vehicle implies, have gone around the globe with the 
machine. An Arab, accustomed to the fleetness of his 
steed, might at first liken the speed of an automobile to 
that of his favorite horse, but he would soon find out 
the inadequacy of his comparison owing to the ability of 
the machine to maintain a high speed all day, and so he 
would be reduced to the necessity of speaking in terms 
of the speedometer. When travel on foot was the general 
method of locomotion, the Germans expressed distance 
in terms of time, e.g., two hours, ten hours; now that 
trains and automobiles have made travel more varied, 
they express it in kilometers. The next town may still 
be four hours away to the villager, but the distance to 
Berlin is 300 kilometers. Examples might be multiplied 
ad infinitum to show that geographical environments 
merely gave figures of speech to describe activity or 
express ideas, but did not influence mental life any 
further. The hell of the Eskimo may be a place of dark- 
ness, storm, and intense cold, that of the Jew one of 



HEALTH AND WORLD-PROGRESS 149 

eternal fire; in both cases the description of the future 
place of punishment is borrowed from local conditions; 
but the idea of punishment— both present and future— is 
independent of them, and will arise simultaneously in the 
tropics and in the artics because it is an expression of 
social needs. In proportion as numerous and varied activi- 
ties create more individual and social needs, they have to 
be expressed in terms of language, and naturally enough 
in words and similes of the environment, because men- 
tality is insufficiently developed in lower civilizations to 
coin a new general or specific term. Activity depends, 
however, on health, and only the direction it takes will 
be somewhat influenced by the environment. The South 
Sea islander will naturally be a seafarer, because that is 
the only way he can find an outlet for his energy ; the 
Kirghis will be a hunter or a shepherd, because that occu- 
pation alone is open to him to make a living. But whether 
Samoan or Samoyede, a sick man wants to be disturbed 
as little as possible, and hence develops only the language 
of the sickroom— moans and groans ; neither the broad- 
ness of the sea nor the beauty of the mountains can stir 
his preoccupied mind to invent anything else, unless it be 
maledictions,— at least while still an unsophisticated 

heathen. 

This inadequacy of accounting for man's mentality by 
geographic factors may be seen better by Miss Semple's 
reference to "The great man in history" where she 
mentions Daniel Boone, " that picturesque figure leading 
the van of the westward movement over the Allegheny 
Mountains, who was born of his frontier environment 
and found a multitude of his kind in that region of back- 
woods farms to follow him into the wilderness." " Not 
a word here about the intense vitality of this man who, 
|K)twithstanding all his hardships and privations, lived to 



il 



11 



150 HEALTH AND SOCIAL PROGRESS 

the age of eighty-five years; nor any word about those 
who owing to poor vitality had to lag behind, but who 
were just as certainly the result of their " frontier en- 
vironment " as Boone. The men who left New England 
villages for the Middle West and the Far West had 
been just as much exposed to the geographic environment 
of New England as had those who stayed behind; they 
had been brought up under the same climatic conditions. 
Yet, there was a difference between the two. Wherein 
does it consist? The diflFerence is one in health. The 
pioneers of every kind have almost always enjoyed good 
health, and they sought an outlet for their abounding 
vitality in new fields and under difficult conditions, be- 
cause they felt confident that they could master any 
circumstances. This confidence is always bred by fine, 
abounding health, as anyone may witness for himself if 
he compares his own hesitancy and timidity in times of 
indigestion or general low vitality with his courage and 
determination when he is well and strong. 

(HI and IV.) The economic and social effects, and ef- 
fects upon movements of peoples owing to geographic 
environment, mentioned by Miss Semple, do not call for 
special comment, since the purpose of our remarks, was 
not to prove those theories to be untrue, but rather to be 
inadequate and vague. That natural barriers, like moun- 
tains and the sea, affect the economic systems of peoples, 
is undoubtedly true ; but that they are the determining in- 
fluence, is just as undoubtedly false. If some islands are 
barren and support a scant population, others equally 
barren, e.g., Malta and the rocks of Tyre and Sidon, may 
support a compact and teeming population whose influ- 
ence may be felt all along the Mediterranean and down 
the ages of history to the present time. If mountains are 
an obstacle to travel for a primitive people, this is so 



HEALTH AND WORLD-PROGRESS 151 

only for those of low vitality ; since from the mountains 
have come the conquerors of the world from immemorial 
times, at least as far as history records them. Rivers 
and other favorable conditions may help, but do not de- 
termine the migrations of peoples. Those of low vitality 
stay home no matter how favorable circumstances may 
be ; no river will tempt them to leave, and every hilltop 
becomes a Himalaya. 

Peschel refers to the influence of physical environ- 
ment upon man's religion. This is exercised through the 
terrors of nature, influence of food and of the desert. He 
points to the fact that the founders of the great mono- 
theistic religions of the world, Zoroaster, Moses, Buddha, 
Christ, and Mohammed, belong to the sub-tropical zone. 
This zone is one which contains mafly vast deserts. 
" Every traveler who has crossed the deserts of Arabia 
and Asia Minor speaks enthusiastically of their beauties ; 
all praise their atmosphere and brightness, and tell of a 
feeling of invigoration and a perceptible increase of in- 
tellectual elasticity; hence between the arched heavens 
and the unbounded expanse of plain, a monotheistic frame 
of mind necessarily steals upon the children of the 

desert." " 

On the other hand, " Buckle believes that the sublime 
and terrible aspects of nature in India, exerting their 
depressing influence upon the minds of the inhabitants 
for many centuries, have been a considerable factor in 
the development of all that is inconsistent and supersti- 
tious in the Hindoo culture. The threatening aspects of 
the external world have filled the minds of the people 
with images of the grand and the terrible which they have 
striven to reproduce in the dogmas of their theology, in 
the character of their gods, and even in the forms of their 
temples. The ancient literature of India shows evidence 



w 



1'^ 







Di 



152 HEALTH AND SOCIAL PROGRESS 

of the most remarkable ascendancy of the imagination. 
Most of their works on grammar, on law, on medicine, 
on geography, on mathematics, and on metaphysics are 
in the form of poetry. There is an excessive reverence 
for antiquity." ®* He believes that man is affected by 
four classes of physical agents — climate, food, soil, and 
the general aspect of nature. 

The dryness and brightness of the atmosphere of the 
deserts mentioned, the consequent comparative freedom 
from disease germs, and the resulting feeling of invigo- 
ration and perceptible increase of intellectual elasticity, 
are likely to have more to do with a monotheistic con- 
ception than the arched heavens and the unbounded ex- 
panse of plain. Else, why did peoples in other plains, 
such as the prairies, steppes, and pampas, not develop 
monotheistic conceptions? And why did sea-faring na- 
tions, hke the Phoenicians and the Greeks who had a 
more broadly arched heaven and a wider expanse to 
deal with, develop the polytheistic systems of religion 
with the greatest diversity of gods? The possible ob- 
jection that the Greeks had a variegated landscape to live 
in, does not hold, since that objection could be raised 
against Zoroaster, and all the other founders of mono- 
theistic religions, because all of them were living in 
countries where plains and mountains changed the land- 
scape. Of Moses we are told, moreover, that he was fond 
of mountains, since he " saw God on Mount Sinai " and 
received the Ten Commandments there ; and before he 
died he " went up from the plains of Moab unto the 
mountain of Nebo, to the top of Pisgah," evidently be- 
cause the much broader expanse from a high elevation 
with the varied scenery of all the land of Judah unto the 
utmost sea, seemed to him more like the dwelling place 
of Jehovah than the hot, sandy, and dusty plain. Neither 



HEALTH AND WORLD-PROGRESS 153 

was Jesus averse to mountains, since He preached His 
first sermon there, was transfigured there, and captured 
there. The fact that both lived in the desert for a while 
as did Elijah— who by the way *' went to Horeb, the 
Mount of God "—and others, like Mohammed, need dis- 
turb no one, since such a short time would not suffice to 
turn polytheists into monotheists, unless Peschel is will- 
ing to concede miraculous powers to the " arched heavens 
and the unbounded expanse of plain " in some particular 

parts of the globe. 

Concerning Buckle's statement about the mind of the 
Hindoo, it may be more profitable to refer to the humble 
mosquito and the hookworm, as the causes of malaria 
and uncinariasis, respectively, than to the " sublime and 
terrible aspects of nature in India." In a country where 
between 60 and 80 per cent of the people are infected 
with anchylostomiasis and perhaps an equal number with 
malaria— the blood thus never being normal— the imagi- 
nation is apt to become rather lively and unrestrained, so 
that the following tale may not appear incredible to the 
average Hindoo. An eminent man " lived in a pure 
and virtuous age, and his days were indeed long in the 
land, since when he was made king he was a million 
years -old; he then reigned six million three hundred 
thousand years ; having done which, he resigned his em- 
pire, and lingered on for one hundred thousand years 



more. 



♦» »4 



^ This man was the first king, anchorite, and 

saint. But even common mortals lived on an average 
80,000 to 100,000 years. 

We found that the jibaro of Porto Rico is equally 
superstitious and unrestrained in his imagination, and 
that voodooism may be on the same level as the jugger- 
naut or sacrifice of children to crocodiles, for in such 
countries life is made almost unendurable owing to en- 



> 



2 



i 



154 HEALTH AND SOCIAL PROGRESS 

demic diseases and occasional epidemics, so that relief 
from such a condition would be welcomed at any price. 
Buddha, — born in the Himalayan piedmont where ano- 
pheles and uncinaria flourish, and fighting the lassitude 
induced not so much by heat and humidity, against both 
of which there is protection through shade and rest, but 
by endemic diseases against which there is no protection 
except quinine and thymol, — may well have pictured his 
heaven as Nirvana, the cessation of all activity and in- 
dividual life. For low vitality produces aversion to activ- 
ity and begets veneration for the past, since all progress 
has to be bought with the outlay of energy which must 
be abundant if new ventures are to be entered upon. 
Diseases of the kind discussed are more important as a 
cause of low vitality and enervation than heat, as is 
proved by the fact that the sufferers from hookworm in 
Tennessee and the neighboring States with their mild and 
salubrious climate are undergoing the same process of 
degeneration as the Hindoos, although in the one case 
the trouble was formerly laid to the heat, in the other to 
laziness and shiftlessness. We know now that this 
disease is one of the principal causes of decadence. " Is 
it * laziness * or disease that is this very day attracting the 
attention of the United States to the descendant of the 
pure-blooded English stock in the Southern Appalachian 
Range, in the mountains of Carolina and Tennessee, the 
section of our country where the greatest predominance 
of * pure American blood * occurs, despised by the negro 
who calls him *po' white trash'?"" 

If results of this kind are found in a temperate climate, 
in States which are fast filling up with health resorts, 
and among a stalwart population which left England less 
than 300 years ago, one can easily figure out what they 
must be where this disease — usually connected with 



HEALTH AND WORLD-PROGRESS 155 

malaria and most likely with other forms of sickness- 
has been exerting its noxious influence upon untold gen- 
erations under less favorable climatic and civilizing con- 
ditions. While it would be wrong to exclude the heat of 
India as a factor in the mental and physical degeneracy 
of the Hindoos, it can certainly no longer be looked upon 
as the principal cause when similar results are noticed 
on a superior people under really favorable cHmatic 

conditions. 

There has been a strong tendency to lay the blame for 
all the shortcomings of white men in the tropics and 
sub-tropics upon the heat, instead of looking for exact 
causes. Among the latter we find social and moral 
causes as well as those of climate. It has not been taken 
into consideration that many a supposedly moral man 
is kept from wrong-doing in his old home by all the props 
which civilization, family history, association with better 
men, and the whole social system, provide. When this 
man is sent to a people on a lower plain of civilization, 
perhaps in a position of authority with all the tempta- 
tions implied, and all props removed, the inevitable result 
is the revelation of his true nature. He will commit deeds 
for which at home he lacked power and opportunity ; but 
we sympathetically lay the blame on the climate, especi- 
ally in the tropics. When a Sicilian, well-behaved at 
home, turns " black bander " in New York, the climate 
is not blamed, since we lay the cause to poor moral 
training at home, poor police service, or economic con- 
ditions. Only when the Italian tries to make an honest 
living by hard work but fails to do so and goes insane, 
is the climate of New York or New Jersey held responsi- 
ble ; whereas we ought to look for the cause in his poor 
physical and mental condition, which makes it impossible 
for him to cope with a new and complex social environ^ 



156 HEALTH AND SOCIAL PROGRESS 

ment. In the past Providence was looked upon as the 
ultimate cause of our failings; now we are inclined to 
make climate the scapegoat. That is neither fair nor 
scientific. We should look for individual causes. Lord 
Clive gathered treasures for himself in India, Lord 
Kitchener did not; many men have given the general 
low moral tone in African communities as an excuse 
for their failings; Livingstone, fever-stricken and gaunt 
from exhaustion, but still in possession of a good Scotch 
constitution and conscience, maintained a high moral 
standard. If we try to blame the climate, definiteness 
of statement is necessary; but that is generally lacking, 
and a vague term is used to cover a multitude of sins. 
We know that in the case of disease certain forms of 
physical and, mferentially at least, mental derangements 
take place; repeated, as in the case of endemic diseases, 
in hundreds of generations they must produce at least 
grave enfeeblement of body and mind. Would it not 
be better to blame diseases, local or general in the tropics, 
rather than climate ? 

Two books by Ellsworth Huntington have appeared 
recently, w^hich have a special claim for more extensive 
remarks in this connection.* While Buckle and Peschel 
never adduce any but the most general arguments in sup- 
port of their theses about the influence of geographical 
and climatical conditions. Dr. Huntington is, at least in 
the first part of his book, very specific. It may be best 
to have the author speak for himself. He says, (pp. 9 
and 10) : 

" The hypothesis, briefly stated, is this : Today a cer- 



* Civilization and Climate, by Ellsworth Huntington, Ph.D., 
Yale University Press, 191 5; also World Power and Evolu- 
tion, ibid., 1919. References are to the first work only, since 
the second contains no new principle. 



HEALTH AND WORLD-PROGRESS 157 

tain peculiar type of climate prevails wherever civiliza- 
tion is high. In the past the same type seems to have 
prevailed wherever a great civilization arose. Therefore, 
such a climate seems to be a necessary condition of great 
progress. It is not the cause of civilization, for that lies 
infinitely deeper. Nor is it the only, or the most im- 
portant condition. It is merely one of several, just as an 
abundant supply of pure water is one of the primary 
conditions of health. Good water will not make people 
healthy, nor will a favorable climate cause a stupid and 
degenerate race to rise to a high level. Nevertheless, if 
the water is bad, people cannot retain their health and 
strength, and similarly when the climate becomes unfit, 
no race can apparently retain its energy and progressive- 
ness. This does not mean that we are hopelessly at the 
mercy of the changes of climate which any century may 
bring forth. On the contrary, if our diagnosis is correct, 
we may at last hope to be free from the withering blight 
which has overtaken every race from which the stimulus 
of a good climate has been removed. Here, again, the 
case is like that of a water supply. Suppose that a com- 
munity had for generations been subject to repeated 
visitations of a dread disease which decimated the popu- 
lation. Suppose that it should be discovered that the 
disease arose from the drinking water. Finally, let the 
community learn that the water is infested with the bac- 
teria which cause typhoid fever. If no other water sup- 
ply were available, would there be reason for despair? 
The disease would be no worse than before, and there 
would be hope of finding some way of protecting the 
water from contamination. So it is with climate. For 
ages the world appears to have been suflFering because one 
of the many conditions of progress has changed re- 
peatedly from century to century. The disease has been 




158 HEALTH AND SOCIAL PROGRESS 

clear enough, and we have devised many helpful ways 
of treating the patients, although none has as yet proved 
highly satisfactory. This does not mean that the treat- 
ment has been wrong, or that we cannot ultimately suc- 
ceed. It merely means that the neglect of one particular 
phase of the matter has prevented the other helpful 
measures from producing their full effect. If nature 
does not provide the stimulus which seems so effective 
elsewhere, man must himself provide it." 

The case for endemic diseases as the cause of the 
retardation of civilization could not have been stated 
more clearly than by Dr. Huntington. We have dis- 
covered the " bacteria which cause typhoid," malaria, and 
hookworm disease, and have made formerly unhealthy 
regions inhabitable by man, and intolerable climates en- 
durable. The uncertain factor of " climate " has been 
brought down to something specific, and has been con- 
quered, and will be subjected to an ever greater degree 
of control in proportion as we let generalities go and 
search for details. That is the whole thesis of this book. 
Man has progressed in exact proportion as he has made 
himself independent of certain factors in his environ- 
ment. Disease is one of these, and the most important. 
For not even Dr. Huntington claims that we shall be 
able to change the heat of the tropics or the cold of the 
arctics. He admits (p. 285) that the climatic hypothesis 
seems depressing, because to the dweller in less favored 
regions the death knell seems to have sounded for any 
progress, while to the inhabitant of present centers of 
great activity a most disquieting vision of possible retro- 
gression is disclosed. He proceeds, however, to dispel 
these fears. 

In our factories we may introduce changes in tempera- 
ture to imitate those of nature where she does not provide 



HEALTH AND WORLD-PROGRESS 159 

them. Work ought to be regulated according to the 
" seasonal curve of energy," and machines should be 
made to run slowly in winter, faster in the spring, less 
fast in summer, very fast in the autumn. We should each 
one of us go to Florida or Southern California in the 
winter; the Russian peasants might be transported to 
Mesopotamia for a sojourn between October and May to 
help the Turk till his fields, and in the tropics houses 
might be cooled just as we heat our houses in winter, 
or people might have one house in the lowlands and an- 
other in the uplands, varying their residence between the 
two seasonally or even weekly. The thought of the ex- 
pense does not deter the author in the least, since the 
farmers in the tropics will be two or three times as pro- 
ductive as European peasants are at present (pages 289- 
293). 

This may be possible some time ; at least, we may hope 
so. But how about the disease germs? Are they going 
to disappear with these changes in residence and in varia- 
tion of the temperature? Or are tropical diseases likely 
to affect a larger number of people than now ? There is 
only one thing to do — to make the tropics healthy by 
eliminating the diseases as far as possible. Wherever 
modern methods have been applied the three most preva- 
lent and pernicious of them have been conquered — yellow 
fever, malaria, and uncinariasis. It has been done in 
places as far apart as Ismailia, and Stephansort, New 
Guinea; Port Said and the Federated Malay States; 
Khartoum and Italy; Greece and Panama; Cairo and 
Porto Rico ; Hong Kong and Sierra Leone. There is no 
need to wait; we have the means, and we shall soon 
have more. The testimony of physicians of the reputa- 
tion of Major General William C. Gorgas and Sir 
Ronald Rpss cannot be gainsaid, One of the worst 



160 HEALTH AND SOCIAL PROGRESS 

regions on the whole globe has always been the West 
Coast of Africa. Ross reports * that statistics covering 
the period 1881 to 1897 showed a death rate of 75.8 per 
1,000 among the European officials on the Gold Coast, 
and 53.6 for Lagos. In 1911 it was 13.9 for the whole 
of the British West African Colonies ; and the invaliding 
rate was only 25.2 per 1,000. 

No one will claim that changes in temperature are not 
beneficial, nor that too protracted heat or cold are not 
injurious ; and Dr. Huntington is evidently right in call- 
ing our attention to them. But if it is in our power to 
improve health in the tropics now, why wait for that 
golden day when the dwellers in Mesopotamia will be 
glad to entertain ten or fifteen millions of Russian 
peasants during the winter in order to give them a neces- 
sary change of air? Healthy men make their own ar- 
rangements ; it is the sick who need to be told what to do. 

It is only fair to state that Dr. Huntington puts forth 
his hypothesis with hesitation, and freely admits that 
other factors have been important as promoters of civili- 
zation. The theory itself concerns us only indirectly. 
It is briefly as follows : Qimate — temperature, humidity, 
and storminess — either promotes or retards health. If 
there is a proper temperature — " mental optimum of 38 
degrees F. and physical optimum of 60 or possibly 65 
degrees F." (p. 129) — with a certain amount of humidity 
suitable to different localities, and a fair amount of 
storminess to insure sufficient daily and seasonal changes, 
we have an ideal climate. Variations from this desidera- 
tum are possible, but not too far in either direction, if the 
best, or even good, results are to be obtained. On the 
basis of these three features the author constructs a 

* Health Preservation in West Africa, by J. Charles Ryan, 
with preface by Sir Ronald Ross, London, 1914, 



HEALTH AND WORLD-PROGRESS 161 

map of human energy with diflFerent degrees of intensity, 
(p. 142). The "very high" areas cover the British 
Isles, Germany, France, Austria, the Baltic provinces, 
Denmark, Southern Sweden and Norway, Northern and 
Central Italy, and the larger part of the United States. 
These areas are surrounded by others of " high " in- 
tensity, to which are added a few isolated regions, e.g., 
Japan, New Zealand, Patagonia, Tasmania, and some 
smaller ones. The " medium " areas include most of 
Asia, the southern coast of Australia, Mexico, the larger 
part of Canada, the southern part of South America, 
the northern part of Africa, the eastern and southern 
coast of Africa, and a few other smaller areas. The 
" low " areas include the northern and southern parts 
of Asia, the larger part of Australia, the northern part 
of Canada, and the islands of the Indian Archipelago. 
The " very low " areas take in most of South America 
and Africa, and a few other small regions. 

He claims that only in the " very high " areas does a 
high civilization exist at present, because only there are 
climatic conditions favorable. Perhaps no exception can 
be taken as to the actual present conditions. His infer- 
ence is that similarly favorable conditions must have ex- 
isted in the past wherever a high civilization arose, and 
in order to prove its correctness, he has originated a 
theory called " pulsations of climate," covering from one 
to several centuries each. He admits it to be only an 
hypothesis, not accepted as yet by meteorologists for 
historic times, at least. Yet he proceeds to apply it to 
history. Whether there were changes of climate in 
prehistoric times does not concern us here, because we 
are interested only in historic man. Of the Neanderthal 
man we know nothing except that he lived and that his 
intelligence was comparatively low. Our civilization has 



162 HEALTH AND SOCIAL PROGRESS 

not benefited from him in the least. It may be best 
to take up some of Dr. Huntington's historical illustra- 
tions. 

Mesopotamia, (p. 257 if.) the author claims, had a 
high civilization, and was invaded successively by various 
peoples, each of whom became civilized. According to 
his hypothesis they owed this power at least in part to the 
favorably stimulating climate. But how can that be? 
If these peoples were living in a healthier climate, had 
better food and houses, and more advanced means of 
offense and defense, and were generally stronger and 
more intelligent owing to their higher civilization— how 
could another people, inferior in all these respects, 
permanently conquer them? And how, in turn, after 
acquiring all the advantages of their subjects, could they 
be reduced to the condition of slaves or vassals by an- 
other inferior people ? It would be a unique phenomenon 
in the annals of history, since according to hypothesis the 
climate did not change from around 3000 b.c. to ap- 
proximately 500 B.C.— the period in which we have 
these successive invasions. Nowhere in history do we 
find an analogous case. The Huns, the Mongols, and 
the Avars invaded Europe, but they were thrust back 
after a short occupation of parts of it, and perhaps few of 
them remained in the conquered territories. The Moors, 
it is true, occupied Spain for approximately 600 years. 
It is, however, a question whether their energy and civili- 
zation were inferior to those enjoyed by the various tribes 
inhabiting Spain during that period. Everywhere we 
find that a physically healthy and mentally capable people 
succeeds in subjugating a disease-ridden, although per- 
haps more civilized, nation. Mesopotamia was no ex- 
ception to the rule. There, as elsewhere, the people from 
the mountains and highlands, after having acquired strong 



HEALTH AND WORLD-PROGRESS 163 



vitality in comparatively disease-free regions, swooped 
down upon the cities and villages in the germ-laden plains, 
and easily subjected the inhabitants. An efflorescence of 
a higher mental and civilizational life was inevitable in a 
healthy and gifted but undeveloped people under the 
stimulus of contact with a higher civilization, and a life 
of leisure based on slavery. The subsequent infection 
and low vitality in the course of time was just as in- 
evitable. No theory of a change of climate is necessary 
to account for the civilization of Mesopotamia or Egypt, 
which has been similarly ruled by outsiders in historic 
times. 

Another interesting illustration of the hypothesis of 
Dr. Huntington is that of the civilization of the Mayas 
in Yucatan (p. 239 ff.). These remarkable people at- 
tained many achievements of high degree in a tropical 
country. How is it to be explained ? Only by a ** climatic 
change such that the dry conditions which prevail a 
little farther north prevailed in the Maya region when 
these people attained eminence " (p. 242). In the drier 
parts of Yucatan where some of the ruins of the Mayas 
are located, there lives even today a fairly prosperous 
agricultural people ; fevers prevail, but are comparatively 
mild. The Guatemalan highlands with fairly favorable 
conditions are only a hundred miles away. Does this not 
suggest a solution which is almost world-wide in applica- 
tion — the migrations from the highlands to the low- 
lands by a strong and energetic people ? What happened 
in Mesopotamia and Egypt would naturally happen here, 
too, and successive invasions would account for the dif- 
ferent periods in Maya history. 

Dr. Huntington admits that the civilizations of Peru, 
Southern Arabia, Rhodesia, Ceylon, Java, and Indo-China 
cannot be explained on the basi$ of a shifting of climatic 



164 HEALTH AND SOCIAL PROGRESS 

zones, and admits that those of Ceylon and Indo-China 
may be due to migrations from higher latitudes. 

The strongest objection to his theory, Dr. Huntington 
states himself (p. 276 ff.). The North American Indians 
lived mostly in the very high or high energy area, and 
yet never passed beyond the lower stages of semi-civiliza- 
tion. He frankly admits the insolubility of this particu- 
lar case, and falls back on the absence of other factors 
contributory to civilization — chiefly the lack of iron and 
of great men with inventive ability. 

This is a candid acknowledgment of the failure of his 
own theory. Other peoples started out with a similar 
lack of both, and were climatically less favorably situ- 
ated, e.g., the Incas and Aztecs, who were, moreover, of 
the same racial stock. The only explanation is that which 
we have found to apply elsewhere. Most of these Indians 
lived in the belt which includes both malaria and unci- 
nariasis. If these diseases can work so much havoc today 
in the Appalachian Mountains among a formerly sturdy 
people, the inference suggests itself that the aborigines 
must have suffered more. The most highly developed 
tribes were the Five Nations who suffered from malaria 
only; just how severely no one can tell. They were, 
moreover, handicapped in another way. As will be 
shown later, local civilizations can never rise very high, 
because the contacts between individuals are too few and 
too similar to stimulate the mind by divergent sugges- 
tions. In other words, the areas that are comparatively 
free from endemic diseases must be fairly large, or must 
permit intercourse with many nations by the use of the 
sea. The Five Nations were an inland people, and while 
they occupied a very much larger area than the Greeks, 
they were shut off from contact with other nations. The 
prevalence of malaria not only kept vitality low, but 



HEALTH AND WORLD-PROGRESS 165 

prevented an increase of population to a point of density 
where contacts might be fairly varied and numerous even 
among themselves. Contact with the sea is no longer 
necessary in a world-wide civilization, because we have 
the railroads and other means of communication. Hence 
this handicap has been removed, and the hinterlands 
of continents have already been developed, and are likely 
to see a higher civilization in the future. The idea of 
geographers that, just because plateaus are removed from 
the sea, they are incapable of sustaining a fairly high 
civilization, has already been corrected by our artificial 
means of communication. In the past they were isolated ; 
now they are brought into contact with the rest of the 
world.* 

One point more must be mentioned. Dr. Huntington 
testifies (p. 39) to the ravages of malaria on mind and 
body in torrid countries, and claims that tropical diseases 
will always prevail there, owing to the prohibitive ex- 

* It is risky to be a prophet, and it is difficult to foretell what 
will happen in the plateaus and other areas removed from the 
sea. In America we have succeeded in overcoming the natural 
handicaps of isolation. Similar success is likely to be attained 
elsewhere, e.g., in the plateaus of China and in the plains of 
Siberia. Huntington (p. 145) puts the blame of the backward- 
ness of Siberia on climate, yet admits (p. 201) that the isolation 
and newness of the country has much to do with it. Professor 
E. A. Ross in a report of a six months* trip through Russia 
and Siberia claims that social factors are responsible for the 
mental inertness of Russian exiles. They have no stimulating 
intercourse, no large libraries, and above all no incentive for 
action and exertion owing to their more or less strict confine- 
ment. They have no opportunity to study facts at first hand, 
and rotate around the adolescent formulae which they took with 
them ('• Studies in Social Progress," June 1918). Other regions 
now densely populated and highly civilized were once similarly 
looked upon as given over to barbarism. Caesar and Tacitus 
certamhr never imagined what civilization there would be in 
Gaul, England, and Germany in the twentieth century. Human 
factors are not omnipotent, but they are powerful agencies for 
overcoming natural handicaps, and are becoming increasingly 
more so every day. 



166 HEALTH AND SOCIAL PROGRESS 

pense of extirpating them. This point will be taken up 
in detail in chapters 12 and 14. In his latest work he 
admits malaria to have been a factor in the decadence of 
ancient Rome and in modem Turkey, as explained in the 
Note to chapter 7. 

4. The anthropological attempts to explain progress 
are based (a) on the weight of the brain, (b) on the 
form of the skull, (c) on other physical characteris- 
tics. 

The weight of the brain is no longer considered of 
fundamental importance, since we find that some men of 
genius have had smaller brains than the average of their 
nation. The brain of Helmholtz weighed only 45 ounces, 
and that of Doellinger only 37.7. While the white race 
has a generally higher brain weight than the black, the 
differences among the lowest and highest Europeans are 
greater than the average between the white and black. 
After an examination of 2,100 male and 1,034 female 
adults, there is, according to Karl Pearson, " no evidence 
that brain weight is sensibly correlated with intellectual 
ability. Of the five races investigated by the biome- 
tricians, the English have the smallest brain weight. The 
mean of the adult Englishman is 27 grams less than the 
Bavarian mean, 57 grams less than the Hessian mean, 65 
grams less than the Swedish mean, and 120 grams less 
than the Bohemian mean." •• Other brain specialists and 
anthropologists concur in this verdict, e.g., Boas in his 
discussion of " The Mind of Primitive Man," where he 
quotes (p. 24) another passage from Pearson to the 
same effect. Donaldson says : " Size, therefore, has a 
meaning, but it is by no means entitled to dominate the 
whole interpretation of the central system." '^ There is 
no need of carrying the argument further, since the 
burden of proof rests on those who a priori regard ^ 



HEALTH AND WORLD-PROGRESS 167 

association of brain weight and high intelligence in- 
separable. 

The form of the skull is considered still less funda- 
mental, since the same head form is found among the 
most backward and the most advanced peoples. The 
cephalic index of the Bushmen is 75.9, that of the Swedes 
of the central provinces is 76.0, both being sub-dolichoce- 
phalic; both the natives of New Ireland and the Dutch 
of the province of Groeningen have a cephalic index of 
81.0 on the living subject. Similar comparisons might 
be multiplied indefinitely, but would only prove the un- 
tenability of the theory more fully. Other measurements 
have likewise yielded unsatisfactory results. " I think 
all the investigations that have been made up to the 
present time compel us to assume that the characteristics 
of the osseous, muscular, visceral, or circulatory system, 
have practically no direct relation to the mental ability 
of man." »» 

5. Major WoodruflF's theory of the actinic rays is an 
attempt to explain the progress of civilization on the basis 
of a high type of man developed in the Baltic provinces. 
In regard to the various attempts to explain high men- 
tality on anthropological grounds he says : " It should 
be remarked in passing that there is absolutely no rela- 
tion between complexion or skull shape and intelligence. 
We have wonderfully high types of man of every con- 
ceivable complexion and every head form. It is only 
where we take huge numbers and compare types that we 
find the average of the blond type of white men to be 
so much more intelligent than all others as to have been 
the ruling element in Europe since historic times, and 
even long before." •• He advocates a theory propounded 
by Schmaedel at Munich in 1895. The theory main- 
tains that there is a definite relation between the distribu- 



i ' 



168 HEALTH AND SOCIAL PROGRESS 

tion of light and color of man and animals. If we dis- 
tinguish in the sun's rays those of heat, light, and actinic 
power, we find that coloration is intended to protect the 
organism against the dangerous short rays, also called 
actinic and ultra-violet, because these have the power to 
destroy protoplasm and to obstruct metabolism. The 
coloring is, consequently, in proportion to the amount of 
light— dark, brown, brunette, blond; and he claims that 
the human races are distributed according to this principle 
—the dark races living in the tropics where the sun rays 
are direct and burning; the brown in the sub-tropics 
where they are pretty direct, and in the arctics where 
light is strong by reflection; brunette in the lower lati- 
tudes of the temperate zones; and blond in the higher 
latitudes, provided there is sufficient protection from 
the light by forests, moisture or other agencies. The 
"evolution of blondness required, then, a cold, dark, 
northern country— probably a cloudy, rainy, misty, 
forest country— the exact conditions needed for the 
evolution of the brain by natural selection and the 
exact conditions of the countries where we have 
placed the origin of the Aryan or Teuton. What a 
strange outcome that these three words should become 
synonyms— Aryan— Teuton— Blond." >»<> The law is de- 
duced that " the blondness of a European nation is pro- 
portional to the cloudiness of its country." "» The Baltic 
people spread from their original home in different direc- 
tions and were the originators of all civilizations, e.g., 
Greek, Roman, even Egyptian and others; since other 
races could develop civilizations only to a certain degree, 
and needed the contact with and guidance of the brainy 
blonds to rise higher. But in each case they died sooner 
or later, because they had wandered out of their zoologi- 
cal zone. 



HEALTH AND WORLD-PROGRESS 169 

This is the briefest possible statement of Major Wood- 
ruff's theory. In criticism I should like to offer the fol- 
lowing considerations. 

In the first place. Woodruff admits the existence of 
high intelligence among other peoples than blonds, as is 
evident from his own quotation given above. Teutonism 
or blondness is, therefore, not responsible for intelligence. 
In the second place, the severe struggle for existence does 
not necessarily evolve high brain power, as Woodruff 
constantly maintains, else this ought to have developed 
elsewhere under similar conditions. In order to show 
how emphatic he is on this point, one quotation may be 
given from his later work on Expansion of Races, " Cold 
and severe climates are the best for this evolution (of 
the nervous system), because they cause a more intense 
struggle for existence, and the survival of the fittest 
is here the survival of the most active and intelli- 
gent, just as in the terribly severe glacial times only 
the most intelligent survived, and there occurred a 
rapid evolution of brain." "^ That this struggle should 
have developed a high brain power only in the Baltic 
area, not elsewhere, is imposing too much upon our 
credulity, unless we fall back on blondness as an addi- 
tional reason — an argument rejected by himself. In the 
third place, it would be difficult to prove that this race 
of men was the only one to develop a high type of civiliza- 
tion in historic times. How can, for instance, the history 
of Peru and of Mexico with their Incas and Aztecs be 
explained on that theory? There was certainly no blond- 
ness of Teuton origin there. 

What Major Woodruff's theory really means is this. 
The actinic rays are destructive of protoplasm ; hence all 
organisms living in light countries have to protect them- 
selves against these rays by graded pigmentation; but 



I .■■ 



170 HEALTH AND SOCIAL PROGRESS 

some of these rays will always penetrate the skin not- 
withstanding, coloration, and a high vitality is, conse- 
quently, impossible ; the permanent necessity of avoiding 
the direct or reflected light makes, moreover, continuous 
work and with it civilization, impossible. Thus stated — 
and it seems to me the only logical interpretation— his 
theory reduces itself to a question of health. Whether 
the actinic rays have the injurious influence ascribed to 
them, is, of course, another question; the evidence pro 
and con not being sufficient to decide the matter. Major 
Woodruff's proofs taken from the decadence of blonds 
in southern climates and in light northern countries like 
Colorado are susceptible of a different interpretation, as 
we shall see later ; and the experiments carried on in the 
Philippine Islands are insufficient both as to number of 
men and length of time, to confirm or to refute the actinic 
theory. It may be well to quote the conclusion of the 
commission appointed to investigate this problem. After 
stating the number of men under observation— 500 blond 
and 500 brunette soldiers with at least 20 months' service, 
and 568 officers of Philippine Scouts, Constabulary, and 
Manila police force, with an average of 5.5 years' con- 
tinuous tropical service— the results are stated under five 
heads : relative amount of sickness, symptomatology and 
dietetic habits, invalidism to United States, character and 
behavior, and relative frequency of insolation. 

" General summary. It is well known that heat and 
humidity in an experimental chamber, and in the absence 
of light, can produce symptoms similar to those occur- 
ring in a milder degree among residents of the tropics. 
We think it probable that these two factors, combined 
with infections, nostalgia and monotony, account for most 
if not all of the injurious effects seen in tropical lands. 
To explain the conditions met with in the Philippines 



HEALTH AND WORLD-PROGRESS 171 

there seems to be no need for invoking the aid of the 
actinic rays of the solar spectrum. Protection against 
these rays by orange-red clothing was found to be of no 
benefit. It is by no means proved that pigmentation per 
se is beneficial in the tropics. In our investigation of 
blonds and brunettes the evidence was conflicting, some 
facts being in favor of the fair and others in favor of 
the dark-complexioned men. This is what would be 
expected if there were actually no difference between the 
two types as regards their resistance to tropical influences. 
From a consideration of all the data it appears that 
blonds are quite as well able as brunettes to withstand 
the influences of the Philippine climate for a period of 
two years and probably for a period of five and one-half 
years. In case of residence beyond the latter period we 
are not in a position to express an opinion based on ex- 
tensive personal observation." ^°^ In his refutation of 
this criticism Major Woodruff calls attention to the fact 
that he had advised brown and not orange-red clothing 
as a protection against actinic rays, dwells on the admitted 
inadequacy of the experiments particularly as to time, 
and refers to the invalidism of the commissioners them- 
selves shortly after having signed the report.^^ 

The final objection to the actinic theory, or rather to 
the application which Woodruff makes of his theory, 
may be stated as follows : If true, then civilizations of the 
past were always the resultant of the forces of decay and 
degeneration; and civilization would always depend on 
the men from the Baltic region, and could never spread 
far beyond that region for any length of time. True, 
he admits that the source of stalwart men from that 
region will never cease flowing, and civilization is there- 
fore not in danger of ever disappearing. But what would 
happen if the climate of the Baltic region should change 



172 HEALTH AND SOCIAL PROGRESS 

as that of Iceland has done within recent years? This 
may be a groundless fear, but it should nevertheless be 
taken into consideration. Whether every civilization is 
the result of decay is an entirely different question, which 
will be discussed more fully later. Suffice it to say here 
that Woodruff is fully convinced of that fact. " His- 
torians are now pretty well agreed that at the period of 
the greatest literary glory of Greece, 500 B.C., the deca- 
dence of the Greeks was already evident, and it is even 
said that it was complete. It is possible for such neurotics 
to be possessed of great literary, artistic, or military skill, 
as at the present day, and the decadence of the Greeks 
was probably the cause of their art. A wonderful con- 
firmation of this view is afforded by a study of ancient 
Greek statuary which faithfully copies the stigmata of 
degeneration found in modem degenerates, just as though 
their best models from the aristocracy were defective. 
A famous head of Juno has arrested development of the 
lower jaw of marked degree and is the head of a dying 
race. It confirms what we know from all sources, that 
the climate of Greece, practically in the latitude of Mary- 
land, required but seven centuries, or thereabouts to 
destroy its blonds." ^^^ 

Since Major Woodruff does not quote any historians 
to support his claim, it is rather difficult to find out who 
they are. One historian may be quoted, though, to show 
that Greek degeneracy began later than 500 b.c. 
Mahaffy, in speaking of the numerous plots and revolu- 
tions started by exiled Greeks in their native city-states, 
ends the discussion with these words : " These scenes of 
violence play so large a part in our Greek histories that 
you will wonder how any such people could be a model 
to others in methods of politics, and it is for that reason 
that I think it necessary to notice the matter. When 



HEALTH AND WORLD-PROGRESS 173 

we look below the surface we shall find that there were 
elements of order never eradicated, and that the crimes 
of the leaders of society did not infect the common sense, 
or destroy the safety of the mass of people, until the 
general decadence in the days of Polybius and the Roman 
interference." *<»• This happened fully three centuries 
later, since Polybius was born 204 and died 123 B.C. 

In regard to the degeneracy of the famous Juno, no 
date is given, and it is consequently impossible to decide 
whether it is from the fourth or second century B.C. 
or even later. The degeneracy of Socrates, Antisthenes, 
and Diogenes — even if real — need not be an indication of 
Greek decadence, since no one would judge Germany of 
today by Nietzsche, or England by Oscar Wilde. The 
men who fought at Marathon, Thermopylae, and Salamis 
were certainly not degenerates, but men of high physical 
and mental attainments. In a previous chapter, specific 
and sufficient reasons have been given for the decadence 
of Greece, even granting now that these men were of the 
blond Baltic type as Major Woodruff claims. 

This is, however, not by any means certain, since Ripley 
is of a different opinion. Speaking of the one hundred or 
more well-authenticated crania left to us, he says : " The 
testimony of these ancient Greek crania is perfectly har- 
monious. All authorities agree that the ancient Hellenes 
were decidedly long-headed, betraying in this respect their 
affinity to the Mediterranean race, which we have already 
traced throughout Southern Europe and Africa. — As we 
shall see, every characteristic in their modern descendants 
and every analogy with the neighboring populations, lead 
us to the conclusion that the classical Hellenes were dis- 
tinctly of the Mediterranean racial type, little different 
from the Phoenicians, the Romans, or the Iberians." *«^ 
One more statement should be made before proceeding 



\^^b 



174 HEALTH AND SOCIAL PROGRESS 

to our own theory. The effects of heat and hun.idity, if. 
coincident, are disastrous; one without the other not 
nearly so. As illustrations we may cite the dry heat of 
some deserts where, notwithstanding a high temperature, 
people are healthy, e.g., some parts of the Sahara and 
of Arabia ; while the west coast of Ireland, the lake re- 
gions of England, and the northwestern coast of the 
United States are likewise healthy, although they are 
rather wet. It is excessive heat, together with great 
humidity, that forms a most deadly combination for 
people not acclimated to it, as the mortality on the west 
coast of Africa proves. This mortality is generally 
ascribed to climate, or more particularly to the combina- 
tion of heat and humidity. But it seems that a different 
interpretation is possible. If heat without humidity is 
not necessarily injurious, nor humidity without heat, the 
combination is deadly because it is only in such a medium 
that certain disease germs can live. Neither the para- 
sites of malaria nor those of uncinariasis can live without 
both heat and moisture; hence people living in places 
where either of these features is absent, are healthy and 
strong, other conditions being equal. It is, therefore, not 
so much the combination that seems to be disastrous to 
man, as the fact that it provides the necessary conditions 
for the growth of these parasites ; and if man can protect 
himself against them — as he is now able to do — the pros- 
pects of even these most deadly regions becoming in- 
habitable to people from higher latitudes, seem at least 
fairly bright. As an illustration of what can be done, yel- 
low fever may be cited. This disease was for a long time 
considered to be due to climate, because it occurred chiefly 
in the tropics. But since the demonstration in 1900 by 
Major Walter Reed, of the United States Army, showing 
that the mosquito stegomyia is the carrier of the yellow 



HEALTH AND WORLD-PROGRESS 175 

fever parasite, and the cleaning of Havana by Colonel 
Waring, we have come to the conclusion that it is amen- 
able to treatment by human beings, and its eradication by 
all civilized communities has proved once more the spe- 
ciousness of reasoning which vaguely attributes certain 
effects to climate instead of to specific causes. As long as 
persons wander into the tropics and are stupid enough to 
expose themselves to a hot, glaring sun while the natives 
shun and avoid all work during the hours of noon, they 
are like the proverbial man who doesn't know enough to 
get out of the rain; since exposure of that kind is equal 
to the folly of trying to sleep outdoors in the Adirondacks 
during the winter — unless one be specially protected. It 
may not kill, but it is certainly injurious. In looking for 
causes of breakdowns in the tropics, individual and social 
habits are as often responsible as certain diseases ; the two 
combined will explain the vast majority of physical and 
mental breakdowns ; and the " climate," if given as a 
cause, should be reduced to specific terms, or not men- 
tioned at all. Man is sufficiently inclined, as it is, to shift 
responsibility; and the climate has served in too many 
cases as an excuse for individual predisposition and in- 
clination to evil. Only by looking for specific causes 
will it be possible to determine whether the tropics and 
sub-tropics are habitable for white men. " The question 
as to the ability of races to thrive under conditions of 
temperature other than those of their ancestors is one 
which has received considerable attention. It has long 
been held that the tropics could never become a field of 
conquest for the nations of the temperate zones, since 
the climate rendered occupation by them impossible. Not- 
withstanding the fact that distinguished observers main- 
tain this, experience seems to demonstrate that acclima- 
tization depends very largely upon a rigid observance of 



TtBT 



;!n; 



176 HEALTH AND SOCIAL PROGRESS 

sanitary and hygienic rules, and many places which were 
once considered fatal to the white man are being proved 
comparatively healthful. When we consider that they 
have lost their bad name solely by an exercise of local and 
personal hygiene, we must not despair of the power of 
man to reduce the unhealthfulness of even large areas in 
tropical climates." "® 

In order to illustrate from another point of view how 
necessary it is to look for specific instead of general 
reasons, we will refer to geophagy or dirt-eating. Deni- 
ker ^®* states that the custom is widespread, occurring in 
Senegal, Persia, especially the Asiatic Archipelago, India, 
South America, Java ; and gives as reasons the desire for 
a beautiful complexion, and the necessity of supplying 
the deficiency of mineral substances among vegetarian 
nations. It does not seem to have occurred to him that 
in all of the countries mentioned, uncinariasis is very 
prevalent, and may possibly be a cause of geophagy. 
Reading of the " sand-lappers " in South Carolina being 
hookworm victims, I wrote Dr. Charles W. Stiles asking 
whether this custom was not a result rather than a cause 
of the disease. In reply he states that it seems quite clear 
to him that dirt-eating is a result, and not the cause of the 
infection with hookworm; and refers to the fact that 
this habit is known to occur among elephants, dogs, and 
sheep when infested with various intestinal parasites. 

It may be well to say a few words in conclusion. It 
has not been our intention to deny the validity of certain 
factors as means to progress, but to insist upon the state- 
ment of specific reasons instead of being satisfied with 
attributing civilization to general causes, e.g., head form, 
brain weight, climate, or actinic rays. These factors 
have undoubtedly some influence, but they are all beyond 
our control at present, and we are likely to make little 



HEALTH AND WORLD-PROGRESS 177 

headway as long as we are content to take them as the 
principal causes. If we try, however, to look for specific 
causes, and find that they produce definite effects, we are 
more likely to attack certain problems in a definite man- 
ner, and arrive at results; and that is the only way to 
make progress. It may seem as if we had over-empha- 
sized the importance of the two diseases mentioned. We 
have stated, however, that they are not the only ones, 
for there are many others which infest the tropics and 
sub-tropics. None of these is, however, as widespread 
or generally and specifically as injurious to whole popula- 
tions as malaria and uncinariasis ; neither have they been 
studied so extensively and intensively, nor have such 
definite results been attained in combating them as with 
these two. The purpose has been throughout to call at- 
tention to results both of the disease and of the cure, and 
to show that we can advance only in this manner. Just as 
I write this, the daily papers report that an interesting 
investigation is to be made by Dr. E. L. Atkinson, the 
parasitologist of the Scott Antarctic Expedition. He pur- 
poses to find the parasite in the Yang-tse River which 
causes a serious, and even deadly, disease among those 
who work in and about rivers, and if successful, to dis- 
cover a remedy. In view of what has been already 
achieved with typhoid and yellow fever, malaria, hook- 
worm, the bubonic plague, and other diseases, it is very 
probable that Dr. Atkinson will succeed, and we shall 
have important results, hitherto attributed to cilmate or 
something else, assigned to a specific cause with which 
we know how to deal. An intelligent society should be 
telic ; that is, attack its problems in a scientific and defin- 
ite manner, otherwise it relapses into the condition of the 
semi-civilization of Mohametanism which charges its 
shortcomings to Allah. 



CHAPTER XI 

HEALTH AND WORLD-PROGRESS (Continued) 

In the last chapter an attempt was made to explain the 
inadequacy of various theories to account for European 
civilization. It becomes necessary to present a different 
view which is more in accord with the facts. 



II. PROGRESS EXPLAINED ON THE BASIS OF HEALTH 

In order to account for progress on the basis of health 
it may be advisable to keep in mind the five laws stated 
at the end of the fifth chapter. Briefly stated, they dealt 
with progress — possible only with surplus energy; with 
work — ^possible only with wisely controlled energy ; with 
social personality — possible only through mutually help- 
ful and sympathetic relations with others; with civiliza- 
tion — ^possible only through interdependence of persons 
and peoples resulting in exchange of mental and indus- 
trial products; with general development — possible only 
through increased self-reliance. In each case we found 
health to be the necessary foundation for these various 
forms of expansion. Civilization is in its ultimate es- 
sence a form of expansion, passing from physical buoy- 
ancy through intellectual, emotional, and volitional depth 
and breadth to self-reliance, and thus to confidence to con- 
trol nature and man's destiny. We believe that these laws 
will be illustrated directly or indirectly in the following 
pages. 

Man must have begun his career as a human being in 
a warm country, since such a locality alone could furnish 

178 



HEALTH AND WORLD-PROGRESS 179 

sufficient food to him whom nature had failed to supply 
with any effective weapons for defense or offense. 
Whether this place was near the equator or near the 
poles, and whether there was only one progenitor or 
several for the various races, are questions which do 
not concern us. The only problem which interests us is 
the relation of health to progress. 

We have seen that neither head form, nor brain weight 
can fully account for intelligence — the only weapon which 
man developed in the course of time. How did he accom- 
plish that? Wherever man had enough food to generate 
surplus energy over his immediate needs, this opportunity 
was provided. Generally speaking, any tropical or sub- 
tropical region will furnish an abundance of coarse food 
in the form of fruits, berries, roots, nuts, and other 
plants. There are likewise small animals on land and in 
the sea which supply at least occasional changes in the 
regimen of vegetable food. Man was thus able to live 
and multiply almost in any warm climate. But while 
food was to be had anywhere in those regions, health was 
not. The very climate in which it is easiest for man to 
subsist, is likewise most abounding in disease germs of 
various kinds. Manson enumerates about 30 diseases as 
" tropical " in the metereological rather than geographical 
sense. All other diseases may, of course, occur in those 
regions ; e.g., in Porto Rico there are at least one hundred 
and fifty-two. We have seen what havoc two of these 
diseases may work, and it is easy to conjecture that life 
in a locality where practically every person suffers from 
at least one of them, many from two — since uncinariasis 
and malaria at least may be simultaneous — ^must have 
been what Victor Hugo describes in the words : " It is 
nothing to die ; but it is frightful not to live," that is, not 
to live healthily, or to live with constant pains and ache$. 



180 HEALTH AND SOCIAL PROGRESS 

With the vast majority of people affected by disease, with 
food coarse, innutritious, and often irregular — it was 
practically impossible to store up any surplus energy to 
improve one*s lot, for all innovations require extra effort, 
and that is impossible to those of low vitality. Man in 
those regions has made but little advance to this day, 
owing to the permanence of tropical diseases. A hook- 
worm or malaria victim may have enough energy to toil 
and slave for the simple food he eats, when the pangs of 
hunger drive him, but beyond that he is unable to go, 
simply because much of the time he must rest and sleep 
from sheer weariness. The jibaro of Porto Rico toils 
long hours sometimes, but in a mechanical way. The in- 
habitants of hot climates are, as a rule, listless, uninven- 
tive, apathetic, and improvident, not so much because of 
the heat, against which there is protection through shade, 
but owing to the various parasites which infest their blood 
and digestive organs, from which in lower civilizations 
there is no escape. Whatever energy is generated from 
food, is consumed in the performance of mere physiologi- 
cal functions; any possible surplus goes to feed the 
myriads of parasites, and none is left for activities which 
make leaders and inventors. If by any chance some 
chieftains or warriors escape the worst effects of low 
vitality, owing to better food and more rest, their energy 
will expend itself in acts of cruelty and vice, since the 
balance of good health is missing and thus no control is 
exercised over the purely physical instincts. No progress 
is possible in those regions where disease germs abound, 
unchecked by the science of man. 

We have given the percentage of people suffering from 
uncinariasis in many countries. Malaria is spread over 
even a wider area of the globe, since it extends farther 
south and farther north, Th^ so-called, "deadly 



HEALTH AND WORLD-PROGRESS 181 

climates " always mean malarious countries. And this 
disease parallels anchylostomiasis in its power to make 
people anaemic, since the malaria parasites attack the red 
corpuscles and cause a reduction of hemoglobin, of the 
latter, often by 40 per cent in a few days and of the 
former by 60 or even 80 per cent. It stands to reason 
that where the whole population is afflicted with even 
one of the numerous tropical diseases, no energy is left 
for any but the absolutely necessary activities — physio- 
logical functions imperatively demanding satisfaction. 
Every inhabitant of those regions is in a pathologic con- 
dition owing to one or another disease peculiar to the 
country. Even slight affections are not without signifi- 
cance ; for, in a stock of low vitality, attacked by malaria 
in childhood and by uncinariasis after puberty, but little 
is needed to shake the constitution to its very founda- 
tions. While mortality from malaria is estimated to be 
only 1,130,000 in an ordinary year all over the world, this 
number represents an enormous amount of suffering and 
loss of labor, often when the latter is most valuable. 
The aftermath is frightful, since the drain on the consti- 
tution is heavy, and various other diseases, e.g., neuras- 
thenia, vascular or cardiac troubles, find ready victims 
owing to the excessive calls on the energy of these organs 
due to the exhaustion of the whole body. As a result of 
the poor quality and large quantity of coarse, bulky, in- 
nutritious food, many, if not the majority of people in the 
tropics and sub-tropics are in a state of chronic starva- 
tion. They live, consequently, on the borderland between 
health and disease, and a number of parasites of any 
disease may prove the last straw to break the camel's 
back. And the chronic character of these diseases permits 
hardly anyone to escape. How can any surplus energy 
be generated under these condition?? They are a mo?t 



182 HEALTH AND SOCIAL PROGRESS 

miserable people. " The dwellers in a malarious region 
like the Terai at the foot of the (Himalayas) are miser- 
able, listless, and ugly, with large heads and particularly 
prominent ears, fiat noses, tumid bellies, slender limbs 
and sallow complexions; the children are impregnated 
with malaria from their birth, and their growth is at- 
tended with aberrations from the normal which prac- 
tically amount to the disease of the rickets. The malarial 
cachexia that follows definite attacks of ague consists in 
a state of ill-defined suffering, associated with a sallow 
skin, enlarged spleen and liver, and sometimes with 
dropsy." ^" H as many as 60 to 80 per cent of the popu- 
lation are victims of malaria, and about 75 per cent of 
uncinariasis — equally disastrous in its consequences — it is 
not difficult to see that such a people cannot generate 
sufficient energy for any but the absolutely necessary ac- 
tivities for sustenance. So miserable is the condition of 
most people in warm climates that intoxicants and nar- 
cotics are generally resorted to to find a little relief from 
the continuous feeling of depression and lethargy. This is 
most probably the explanation of the almost universal 
use of artificial stimulants, especially when we find that 
those of low vitality among civilized peoples resort almost 
without exception to some kind of exhilarating drink or 
drug. 

The condition of all countries in the tropics and sub- 
tropics has been similar to the one described in the case of 
Porto Rico, with variations in some localities for better, 
in others for worse. The debilitating influences of en- 
demic diseases have played an incalculable part in the 
history of all warm countries. The present condition of 
southern and central China, India, Central America, and 
very large parts of South America, the West Indies, 
practically of all Africa and other parts of the tropics and 



HEALTH AND WORLD-PROGRESS 183 

sub-tropics, is accounted for to a large extent by the 
ravages of these diseases, unchecked for many centuries, 
and therefore cumulative in their effects on succeeding 
generations. If even in the Southern States of the Union 
with their numerous healthy localities, the subjects of 
malaria and hookworm are almost branded by their ap- 
pearance and low social character as beings of a dif- 
ferent race, the results in a generally lower civilization, 
with worse sanitary conditions, must have been much 
worse. Men cannot live generation after generation on 
a low vitality plane without physical, mental, moral, and 
social deterioration. People whose amount of energy is 
so small that they cannot perform any but the most neqes- 
sary activities, and these only by forcing themselves be- 
cause of constant aches and pains, soon become self- 
centered and unsocial, lose control over themselves and 
with it self-respect and moral sense. Their attitude is 
one of carelessness, listlessness, and general apathy. The 
indulgence of the physical appetites is their only concern, 
since the nervous system is disintegrated, and the in- 
stincts are no longer under the control of a well-balanced, 
healthy constitution. 

We have an analogy here to what happens in old age 
with the breaking up of the nervous and digestive sys- 
tems. Because of the lowering of vitality many old 
people become pessimistic, irritable, contentious, and 
even moral perverts. The control of the whole over the 
parts is lacking, and small incidents will disturb whatever 
balancing elements are left. Under these conditions wild 
ideas easily find admission. A healthy man has a stand- 
ard in his own ability of performance for whatever can 
be done, and is therefore in a position to judge the per- 
formances of others. If anyone promises too much or any- 
thing that passes the range of his comprehension, he will 



184 HEALTH AND SOCIAL PROGRESS 

become cautious and skeptical. It is difficult to deceive 
him more than once. The sick man has his fancies, and 
in acute cases, his delirium, just because the diseased 
part no longer serves the whole in an unobtrusive and 
effective manner, but asserts itself and throws the entire 
system out of order. What happens, however, in his case 
in an acute form, happens in that of devitalized persons 
constantly in a milder degree. The one desire is for a 
feeling of buoyancy and well-being which they have ex- 
perienced in the few moments of occasional relief. Ow- 
ing to their inability to measure performance on account 
of their own defects, they readily accept promises of 
help and relief, no matter how fanciful. The psychology 
of patent medicine vendors and consumers is based on 
this principle. The vendor knows that those ailing from 
some trouble can easily be induced to believe their diffi- 
culty to be greater than it is; and so he works up a 
description of symptoms which is certain to tally with 
some of the patients* feeHngs. The consumer, already 
off his guard through the general tendency of illness to 
deprive one of a proper sense of proportion, becomes 
alarmed, believes, and buys. In a population where prac- 
tically everybody lives on a low vitality plane and where 
many are actually sick, there is no general standard for 
the performance of the possible, and superstition, cre- 
dulity, and a general lack of estimating promises at their 
true value, are the result. The pessimism of old age, 
too, can be explained on this principle. Power to per- 
form is in a large measure gone, and there is just enough 
energy left to resent this inability. But man cannot live 
in a resentful mood for a long time without changing the 
tone of his whole attitude. For a time he may be satis- 
fied in speaking about the superior performances of his 
younger days. This soon becomes tiresome, and inability 



HEALTH AND WORLD-PROGRESS 185 

to act effectively creates a feeling of distrust in the value 
of one's own actions in the course of time. The final 
result is pessimism or perhaps superstition, even in as 
brilliant a man as the late Alfred R. Wallace in his old 
age. Lombroso is another case in point. 

The application of this general principle is not far to 
seek. The connection of endemic diseases and of Nir- 
vana was hinted at in the last chapter. This may have 
seemed fanciful, but on the basis of the principle just 
stated, it appears less so. Where every possible means to 
rid oneself of continuous suffering has failed, and where 
misery is the one permanent and universal element in 
the social environment, the whole of individual existence 
comes to be regarded as consisting of pain, and the 
annihilation of individuality or the ceasing of activity in 
Nirvana must appear as the only way of solving the 
problem. The average Hindoo, not being sufficiently 
educated to comprehend such a doctrine, just as naturally 
resorts to various superstitions as means of relief; and 
the numerous practices of the most revolting character in 
the religions of India amply testify to what depth of 
degradation a people can descend when constant physi- 
cal suffering, even in a mild degree, perverts the whole 
mental attitude toward seeking relief at any cost. The 
voodooism of the Porto Rican negro was referred to as 
due to a similar source. In short, it seems to me, tfiat 
many superstitions in religion and other departments of 
life originated in a feeling of inability to perform, and 
in the consequent absence of a personal measure for the 
value of promise to perform. But the whole of the tropi- 
cal and of the ancient world has been subjected to this 
inability owing to the practically general occurrence of 
endemics and frequent epidemics; hence all of the re- 
ligions originating there are not only full of superstitions, 



I 

■:i.t 

I 



SI 



H' 



i 

'■J 

I 



186 HEALTH AND SOCIAL PROGRESS 

but express above all else the ardent desire for relief 
from suffering. 

The principle stated may be applied also in the political 
realm. The civilized world is informed almost every 
year about a revolution in one of our Central and South 
American republics. These people have what the politi- 
cians and statesmen always talk about — free institutions, 
liberal constitutions, and for the minority, at least, a fair 
system of education. Yet, it is the most educated in those 
countries who are plotting and counter-plotting, and each 
new aspirant for presidential honors readily finds ad- 
herents. How does he get them? By promises of vari- 
ous kinds, all of which are plainly Utopian. Yet, to the 
peon of Mexico, or of the different republics of Central 
and South America, they seem credible because he has 
never performed systematic work in his life and has, 
thus, no standard to measure the promises of others in 
regard to the possibility of performance. And why can 
he not work? Because he is born with a weak constitu- 
tion, gets malaria during his childhood, has uncinariasis 
in his youth, and never has an opportunity to lay up any 
surplus energy. Hence any demagogue who is shrewd 
enough to make his promises sufficiently glowing, has no 
difficulty in finding adherents, although the least modicum 
of common sense and the oft-repeated impossibility of 
keeping said promises ought to teach these people that 
any plans proposed by the most fervid orator are but so 
many idle words, spoken to enthrall the fancy of a 
multitude incapable of thinking, because bent only on re- 
lief from an intolerable condition. A blind belief in 
promises of any kind has taken the place of clear think- 
ing, and the demagogue appeals to this desire for libera- 
tion from suffering. The present political and economic 
condition of some parts of Europe furnishes a recent 



HEALTH AND WORLD-PROGRESS 187 

illustration of the same principle. Lack of food during 
the World War produced widespread devitalization. The 
result is a belief in all kinds of vagaries, especially in 
Russia where conditions were worst. These people have 
lost optimism and self-control. 

Whichever way we turn, then, the phenomenon of low 
vitality in the warm climates, due chiefly to endemic 
diseases, confronts us with its retardation of progress, 
lack of initiative, and absence of clear thinking. For 
whatever the ultimate explanation may be, the primary 
fact remains that the phenomena of consciousness are 
inextricably involved with physiological conditions; 
they are exalted or depressed with the latter; they un- 
fold and flourish with the health and vigor of the organ- 
ism; and decline or fade away with the deterioration of 
the body. The human body is an engine for the con- 
version of food into energy. In proportion as the engine 
is supplied with good fuel and is kept free from friction, 
will the energy be greater and expended more economi- 
cally. 

In the warm climates the food is generally poor and 
the friction in the organism is great and incessant, owing 
to parasites; hence no surplus power can be generated, 
and, inferentially at least, no high mentality can be 
created. The result is stagnation within and retardation 
of civilization introduced from without. 

Mexico will serve as a good illustration of this con- 
dition of things. It is the treasure vault of the globe, 
not only by virtue of its mineral wealth but by its agri- 
cultural potentialities. But though Mexico is rich, Mexi- 
cans are very poor; they can, moreover, never be rich 
unless the conditions of health are changed among the 
peons. When the vast majority of a people is under the 
influence of debilitating diseases — and Mexico has a 



I 



188 HEALTH AND SOCIAL PROGRESS 

large amount of malaria and uncinariasis beside many 
others — persistent work is out of the question, and work 
alone will bring wealth to a country. These people are 
without energy, merely doing enough to meet their few 
elementary needs. When aroused into some kind of 
frenzy, as is apt to be the case with mentally poorly 
balanced people, they become cruel and irresponsible. 
The world has been shocked many times by savage acts 
of cruelty on the part of soldiers and officers. The revo- 
lutionists shoot down the defenders of any established 
government in cold blood, and any revolutionist is treated 
as a traitor. It is better to die on the field of battle 
than to become a prisoner, since massacre of prisoners 
goes on from decade to decade. Having a poorly bal- 
anced nervous system owing to poor food and internal 
parasites, the peon can be stirred only by the promise 
of the satisfaction of his elemental passions for loot, re- 
venge, and violence. These are easily aroused and the 
leaders see to it that they are satisfied; and any bandit 
making promises in this manner will find ready followers. 
When not aroused the peon is about as lazy and inactive 
a being as physiological necessities permit him to be. 
This may explain why Porfirio Diaz created a most ef- 
ficient corps of rurales from bandits and leaders of rob- 
ber bands. These men had shown at least sufficient 
energy to be bad, while the average peon merely gave 
evidence of an unconquerable desire to eat, drink, and 
sleep, perhaps to loaf when not too tired. Only a hope- 
lessly devitalized people would permit a government such 
as Mexico has had — ^a handful of Spaniards in alliance 
with a small section of the mixed race has held all the 
offices in the courts, army, and administration. And not 
once have the lower strata of the population risen in 
revolt against this small dan. Revoltttions there have 



HEALTH AND WORLD-PROGRESS 189 

been, but always instigated and engineered by men of 
this small class against one of their own coterie. And 
as long as the peon remains the mere physical wreck 
which he generally is, no free constitution nor book- 
learning can help him. The mere wish to be free is not 
enough; there must be physical and mental energy be- 
hind the wish to make it a reality. As soon as modem 
medicine brings the necessary relief, the peon will rise 
and crush the whole artificial superstructure of class 
rule. There are a few indications of this already. 

The most progressive states of Mexico are those in the 
north, — Coahuila, Chihuahua, Sonora, and Durango ; they 
have a more temperate climate on account of their great 
altitude, and are more healthful. Endemic diseases are 
not nearly as prevalent as further south and along the 
sea coasts, and the people are stronger, more vigorous, 
and mentally alert. This difference in health may explain 
the various estimates placed on the peon better than the 
theory of race. Diametrically opposite opinions are re- 
ported about him. He is held by some to be a robber and 
savage by nature, while others regard him as extremely 
intelligent and faithful; some consider him a ne'er-do- 
well, others an exceedingly capable workman, improving 
rapidly under instruction. The solution seems simple 
enough. The peon who is ridden by parasites is and 
must be worthless as a laborer, and savage when aroused, 
just as our southern mountaineers are, under similar 
conditions; while the peon who comes from the higher 
altitudes has a better constitution, and is more willing and 
capable to learn when opportunity offers under American 
employment with better pay, treatment, and improved 
housing conditions. The incapables in New York nearly 
all belong to the physically devitalized class, while capa- 
Ue workers in any occupation enjoy at least fair health. 



ll:> 




iV'i 



190 HEALTH AND SOCIAL PROGRESS 

In New York we classify the paupers and ne'er-do-wells 
among the physically defective or at least those of low 
vitality; why not do the same with Mexicans? 

Summing up, we find that low vitality is the cause of 
nearly all the troubles in the tropics, because it means 
inability to perform and achieve, and, consequently, the 
absence of a standard to measure the value of promise to 
perform on the part of others. Hence superstition in 
religion and credulity in politics. For the psychological 
basis of both is inability to perform. This is amply illus- 
trated in more advanced societies in other realms. The 
promoter of various " get-rich-quick " schemes frequently 
and successfully appeals to ministers and teachers, be- 
cause they are not experts in business. It is difficult 
to " beat " a horsedealer in his line ; but he may pay 
fifty dollars for a bushel of wheat " blessed " by a re- 
ligious quack — ^an actual occurrence during 1912 in 
Brooklyn, N. Y. Even intelligent people take to medical 
nostrums when suffering from chronic disease, or adopt 
any medley of religio-philosophical theories. The in- 
ability to perform in any particular line provides an op- 
portunity for the charlatan of every description. 



Fortunately, the conditions just described are not uni- 
versal in the tropics and sub-tropics. There are a num- 
ber of areas free from at least the worst of the debilitat- 
ing effects of endemic diseases ; they are found chiefly in 
the mountains and on small islands in the sea where the 
breezes mitigate the effects of too great heat. We are 
concerned here chiefly with the health of islands in higher 
altitudes, since the islands of the sea have had compara- 
tively little influence on world-progress. 

The zones of altitude are almost as important as the 



HEALTH AND WORLD-PROGRESS 191 

zones of latitude. If a mountain is sufficiently high, it 
may present features of the higher latitudes in the midst 
of a tropical climate, as the temperature decreases 
normally one degree Fahrenheit for every 270 feet alti- 
tude. This means that an altitude of 5,000 feet has a 
temperature by 18 degrees lower than the seashore, and 
in high mountains, such as the Himalayas, there results a 
very considerable range of flora and variety in climates. 
The long incline of Mount Everest down to the sea level 
at Calcutta, comprises in a few miles the climatic con- 
ditions of Asia from arctic to tropic; and the southern 
slope of Monte Rosa, from the glacier cap to the banks 
of the river Po, yields within certain limits all the vari- 
eties of climates in Europe from Lapland to the Medi- 
terranean. In a study of health this is very important, 
since not only heat decreases as we ascend, but absolute 
humidity. Deaderick says that a few hundred feet in 
altitude are equivalent, as far as malarial conditions are 
concerned, to as many miles in latitude, although it may 
occur in places as high as 6,000 feet within the tropics. To 
a certain extent the same holds true concerning uncinari- 
asis, since in Colombia the portion of the population living 
below 3,000 feet altitude is infected to the extent of 
90 per cent, while it scarcely occurs above that level. It is 
interesting to notice here that those portions of South 
America, e.g., Argentina and Chile, which are practically 
free from these endemics, are the most advanced in civili- 
zation, and have the most stable governments. 

The important social and climatic differences which 
may often exist within comparatively short distances may 
be illustrated by a reference to Sweden, where we have 
the Lapps in the north, and only a hundred miles to 
the south, the Swedes; the former merely eke out an 
existence, the latter live in comparative comfort. The 



192 HEALTH AND SOCIAL PROGRESS 

differences in civilization are even greater between the 
two peoples. Other countries show similar differences. 
In the highlands of northern Palestine with their cool, 
moist, and cloudy climate we have the Druses with their 
blue eyes and brown hair ; while in the depression along 
the Dead Sea, about 120 miles south, negroid types sur- 
vive. In the Blue Ridge Mountains we have the Baltic 
type who survive in racial purity, but at their foot, 100 
miles or so away, lives the negro. In central Italy and in 
northern Spain the blonds are f oimd mostly in the cloudy 
uplands, while the darker colored types live in the valleys. 
These cases show plainly, that there may exist great 
differences of climate within comparatively small geo- 
graphical distances, provided that mountains give variety 
to the landscape. 

Another factor may be mentioned here. Certain areas 
and islands are entirely free from a disease, while neigh- 
boring localities are devastated. This immunity is ap- 
parently not due to the absence of unfavorable conditions, 
but rather to the presence of some inimical factor pre- 
venting the development of the parasite. And the prob- 
lem of stamping out malaria and hookworm, for instance, 
will be greatly facilitated if that factor should be dis- 
covered. With the rapid development of medical knowl- 
edge in the realm of bacteria and parasites, it is not un- 
reasonable to hope that such a discovery will be made in 
a comparatively short time, giving us perhaps a new and 
better explanation of these and other diseases and their 
influence upon man. 

Hills, mountains, and the plateaus between them, are, 
then, comparatively free from the effects of most known 
endemics. It was in these localities that a healthier race 
than in the lowlands was developed all through the ages. 
These men are more intelligent and more alert than those 



HEALTH AND WORLD-PROGRESS 193 

in the valleys, just because they are less debilitated by 
disease. The conquerors and the men of initiative in 
the sub-tropics have generally come from the highlands 
all through historic times. The Aryans invading India, 
the Medes, the Assyrians, and even the Kurds of today 
are examples. The ancient civilizations of the Incas in 
Peru and that of the Toltecs and the Aztecs in Mexico 
had their seats in cities located at high altitudes. The 
Incas preferred to extend their conquests along the 
Andean valleys for a stretch of 1,500 miles; they found 
it easier to climb pass after pass and mount to higher 
altitudes, than to descend to the hot, steaming coast where 
man and beast were constantly attacked by parasites; 
when they finally did descend to the seaboard, their de- 
generation soon began and a handful of Spaniards was 
able to vanquish them. The areas which were com- 
paratively free from endemic diseases, have produced a 
high type of man all over the globe, even when they were 
small; and a civilization surpassing that of less healthy 
regions was produced. What was the reason for their 
inability to pursue the course entered upon ? There were 
two; first, migrations into warmer climates; second, the 
limitation of the healthy areas ; or lack of continuity, and 
insufficient extension. 

1. Lack of Continuity. The tendency of man has al- 
ways been toward greater ease, and a cold, perhaps raw 
and damp, climate has rarely proved attractive to any 
race. Hence we have the numerous migrations from the 
higher ahitudes into the nearby valleys, from the plateaus 
of Central Asia both south and west into regions with 
more favorable climatic conditions. Coming into contact 
with more comfortably situated but physically enfeebled 
races, these healthier tribes had no difficulty in subduing 
them and establishing new governments. A higher civili- 



h 
f1 



194 : HEALTH AND SOCIAL PROGRESS 

zation resulted, since minds were stimulated by this con- 
tact, and the conquerors — having enslaved the native races 
— had leisure to develop whatever capacities they had. 
For a while things went well, and in a number of in- 
stances remarkable progress was made. Then the inevi- 
table decline began, owing to the fact that the con- 
querors were unable to withstand the diseases of the 
warmer climates, in which they had never had any racial 
training. In the course of time they degenerated, and 
eventually died out. The civilization which had been 
essentially the work of a healthy race, could not be con- 
tinued for long by the enfeebled native races, and sooner 
or later passed away; and the partially civilized natives 
relapsed to lower levels. 

India and Egypt are good illustrations of this process. 
The native races of India were never able to attain a 
high level by their own efforts, since with the conditions 
of health indicated in previous chapters, this was abso- 
lutely impossible. Egypt was in a similar position. With 
endemic diseases always abounding, no one could live in 
the Nile valley but the fellaheen. From time immemorial, 
conquerors have come from the north and occasionally 
from the mountains of the south to become the pharaohs 
of the country, always imposing their government upon 
the patient peasantry; but the principal parts of their 
civilization which have come down to us are their huge 
tombs, in the building of which thousands of slaves lost 
their lives. Yet the slaves are there today, still toiling 
for new masters from the north; while all the former 
rulers died out long ago, scarcely leaving us their names. 

And so it was with Italy. How many Teutons were 
there who obeyed the call of their Emperors during the 
Middle Ages in order to retain the crown of " The Holy 
Roman Empire of the German Nation," only to find the 



HEALTH AND WORLD-PROGRESS 195 

malaria of the Campagna and of southern Italy a more 
deadly foe than the stiletto of the crafty Sicilian! The 
last of the noblest dynasty of those conquerors, Konradin 
the Hohenstaufen, met a martyr's death, due to the 
inability of his warriors to adjust themselves to the 
parasites. Thus has it always been. The conqueror 
vanquished the enfeebled population of the warmer 
climates ; yet in the course of time he fell a victim to the 
merciless but invisible foe which attacked his blood and 
intestines. The native population, enervated and un- 
progressive but sifted through the survival of the fittest, 
still continues to live and procreate, and is now seeing a 
better day ahead because modern science is able to cope 
with these deadly parasites. 

Civilizations in the past were, consequently, of neces- 
sity ephemeral. One race of conquerors followed an- 
other in the same country; and although some of the 
achievements of former rulers survived, the vast major- 
ity of them were lost, and a new start had to be made 
every time that two races came in contact with each 
other. Continuity of progress is, in other words, es- 
sential to a high civilization; only where achievements 
are handed down through successive generations, can 
the new generations start fairly well equipped for con- 
quests in still unknown fields of knowledge. Owing, 
then, to the debility of races native to warmer climates, 
and to the inability of races from healthier localities to 
adapt themselves to such climates, no continuity of prog- 
ress was possible, nor could any civilization of antiquity 
rise beyond a certain level. 

2. Insufficient Extension. The other reason for the 
failure of the peoples in the healthy areas to rise higher 
was the limitation of these areas. No high civilization is 
ever built up by a single people, no matter how capable 



• 



196 HEALTH AND SOCIAL PROGRESS 

it may be. One must leam not only from predeces- 
sors, but from contemporaries. Exchanges of views must 
not only be ntmierous, but varied. In proportion as a 
capable people enters into friendly relations with other 
fairly well advanced nations, will it develop by receiving 
and giving suggestions. The healthy areas in the tropics 
and sub-tropics are generally of small extent, and hence 
are able to support only small populations, more particu- 
larly in former ages when the means for increasing the 
food supply were limited to the domestication of animals 
and to a crude form of agriculture. Social and religious 
conditions forbade, moreover, too frequent or too varied 
contact with foreign races. Diffidence, which poor health 
always implies, generally prevented people from extend- 
ing their social consciousness beyond the tribal domain, 
since they lacked the courage bom of good health to 
conquer unknown difficulties or even to wrestle with 
those immediately at hand. The expansiveness and good 
nature of vigorous health was a rare occurrence in those 
times, and this is reflected in the social and religious 
creeds of primitive man — and of savage man in all 
climates today — who look upon every foreigner as an 
enemy and every worshiper of a different deity as a 
heretic. The history of religious persecutions even in 
comparatively modern times is a confirmation of this 
statement, since the foremost persecutors of other creeds 
were generally men in poor health — if one may judge 
from their gaunt figures and emaciated features. The 
recent " holy war " of the Greeks, Servians, and Bul- 
garians against the Turks was justly ridiculed by many 
people, ignorant of the sanitary conditions in the Bal- 
kans, since it was a most unholy one, although the 
savagery of all parties was inexplicable to the critics. 
The fact pf the Allies attacking each other after the 



HEALTH AND WORLD-PROGRESS 197 

defeat of the Turks, justifies the inference that the cruel- 
ties perpetrated by all parties to this war and the narrow- 
ness of their social and religious consciousness may be 
due largely to the general ill health of these peoples, 
induced by endemic diseases. We have here another case 
like that of the Mexicans discussed above — ^peoples rav- 
aged for generations by endemic diseases, consequently 
without balance; and, when aroused, satisfying merely 
animal instincts of lust and revenge without let or hin- 
drance. All parties were drunk with blood, and lost all 
control of themselves. Concerning Greece we know that 
malaria is very prevalent, and concerning the other coun- 
tries we simply lack statistical evidence, although the 
disease is widespread and others may exist. (See the 
Preface for an explanation of the inactivity of 750,000 
men owing to malaria.) 

In localities where endemic diseases were at least rare, 
and a healthier stock could develop in the course of time, 
social consciousness still continued to be comparatively 
narrow owing to inherited customs which it is always 
difficult to change, especially among people on lower 
planes of civilization. Hence these people would not 
enter into any but hostile contact with others, and the 
enslavement or extirpation of the defeated peoples was 
almost inevitable. This prevented a profitable exchange 
of views and kept the civilization even of healthy races on 
comparatively low levels, since no single race has been 
able to rise very high unaided by the efforts of others. 
The rapid spread and high development of modern civili- 
zation is among other things due to the rapid extension 
of our means of communication, which has enabled every 
civilized nation to be teacher as well as pupil of every 
other. And the most advanced nations in the spread of 
civilization are, and always have been, the healthiest, 



198 HEALTH AND SOCIAL PROGRESS 

because they have had the courage to face all kinds of 
dangers, and confidence in their ability to cope with all 
sorts of difficvdties. The pioneers in discoveries have 
always enjoyed good, if not abounding, health. 

Two conditions are, then, necessary for a high civili- 
zation—continuity of progress and sufficient extension. 
These two factors have met only in the history of the 
White Race, and more particularly in that of the Baltic 
stock. Since it is admitted that intelligence is not con- 
fined to one kind of pigmentation or to one head form, as 
we saw above ; and since the origin of the physical dif- 
ferentiations is still an unsolved and exceedingly com- 
plex problem — witness, for instance in the case of the 
negro, the existence of a dense cuticle, diminished perspi- 
ration, smaller chest with less perspiratory power, lower 
temperature with a more rapid pulse, and constant sub- 
jection to endemic diseases, all of which variations may 
enter into the question of coloring — we need not enter 
into even a brief discussion of racial beginnings.* We 
are concerned only with the question of higher men- 
tality as the cause of civilization. 

Our direct human ancestors originated in all proba- 
bility in the Indian archipelago, since the oldest human 
remains have been found there on the island of Java. 
From the archipelago migrations took place in a north- 
western direction into Asia, and here the stream divided, 
turning along the coasts, east and west, and northward 
into the higher altitudes; one stream eventually getting 
into Europe and another into Africa. The details of these 
migrations and the problem of the population of America 
and of the Pacific islands, do not concern us. Our only 

* The most acceptable theory is that of Professor Giddings, as 
given by F. Stuart Chapin in Social Evolution, pp. 208-226, 
on the basis of unpublished lectures. 



HEALTH AND WORLD-PROGRESS i 199 

problem is that of the increase of mentality as affected by 
these migrations. The Indian archipelago is notoriously 
insalubrious, and man could make comparatively little 
progress there, as is proved by the low mental condition 
of the aborigines of Borneo and Australia. The further 
north he went, the more healthful were the regions he 
entered ; the stream of migration which eventually turned 
into Africa lost some of the mentality gained during the 
long sojourn in more salubrious regions and dropped to 
lower levels owing to the notoriously bad sanitary con- 
ditions of that continent. 

One question must be answered before we proceed. 
What was the motive for these migrations? The usual 
answer has been overpopulation. Even today the great 
continent-like areas of Borneo, New Guinea, Sumatra, 
and some of the larger islands of the Philippine group 
have a sparse population, and Australia is noted for its 
exceedingly few inhabitants all over the northern central 
districts. It is true that some of the smaller islands in 
the archipelago are densely populated, but this is due to 
local conditions which have been produced by Europeans, 
who selected the most fertile regions favorable for the 
cultivation of special products. A striking example is 
furnished by Amboina, the isle of the famous clove mo^ 
nopoly where the population reaches 1 ,000 per square mile, 
while in the other Moluccas, where Papuan influences are 
strong, it drops to 20. Underpopulation is found over 
the larger part of the tropics. " Economic and social re- 
tardation have kept the hot belt relatively underpopulated. 
The density map shows much the largest part of it with 
a population less than 25 to the square mile. Only the 
small portion contained in India, southernmost China, 
and Java shows a density over 125 to the square mile. 
This density has to rise to 500 or more to the square mile 



200 HEALTH AND SOCIAL PROGRESS 

before emigration begins. The would-be exiles then have 
a wide choice of new homes in other tropical lands, where 
they find congenial climate and phases of economic de- 
velopment into which they will fit." "» Compare this 
statement with the following by the same author. 

"In the tropical highlands of Mexico, Central and 
South America, — concentration of population and its con- 
comitant cultural development begin to appear above the 
2,000 meter line. Here are the chief seats of population. 
Mexico has three recognized altitude zones, the cold, the 
temperate, and the hot, corresponding to plateau, high 
slopes and coastal piedmont up to 1,000 meters;— but the 
first two contain nine-tenths of the people. While the 
plateau has in some sections a population dense as that 
of France, the lowlands are sparsely peopled by wild 
Indians and lumbermen. Ecuador has three-fourths of 
its population crowded into the plateau basins (mean 
elevation 2,500 meters) inclosed by the ranges of the 
Andes. Peru presents a similar distribution, with a 
comparatively dense population, on a plateau reaching to 
3,500 meters or more, though its coastal belt being health- 
ful, dry, and fairly well supplied with irrigation streams 
from the Andes, is better developed than any other simi- 
lar district in tropical America. In Bolivia, 72 per cent 
of the total population live at an altitude of 6,000 to 
14,000 feet, while five out of the nine most densely 
populated provinces lie at elevations over 11,000 feet." "* 
Overpopulation of the tropics cannot, then, have been 
the motive for emigration northward from the Indian 
archipelago, since the stress of population must have 
been less in pre-historic times than it is today. Primitive 
man had, moreover, means, as savage man has today, 
for preventing this calamity by killing off the old people 
and the children. 



HEALTH AND WORLD-PROGRESS 201 

Neither can the motive for migration be found in the 
scarcity of food, since the regions mentioned and the hot 
belt in general are more productive with less labor than 
higher altitudes or latitudes. Any possible scarcity of 
food was easily remedied by cannibalism within the group 
or without by war, since the bodies of slain friends as 
well as of foes could be and were used not only in emer- 
gencies but often as a delicacy. Owing to his general 
aversion to needless exertion man has never entered upon 
long journeys or other hardships without an urgent 
reason. In primitive times he was even less inclined to 
do so on account of his diffidence and his ignorance of 
overcoming obstacles. Yet we see him go north and 
climb mountain slopes to establish a habitat. What was 
the strong motive which induced him to abandon the 
favorable conditions in the valleys of warm climates? 

The dread of disease is the only answer to this ques- 
tion. Even in earliest times man must have noticed the 
tremendous mortality which he found all around him, and 
must have feared a like fate, since the love of life has 
been the one permanent instinct of the human race. The 
" will to live " is, perhaps, stronger in nature-peoples 
than in the civilized, notwithstanding the small value put 
upon life by the lower races. It is one thing to value other 
persons' lives lightly ; it is quite different when it comes 
to one's own. The savage is unsophisticated in this mat- 
ter, and while he has but little to live for, the dread of 
death, once he has acquired sufficient intelligence to form 
an idea of it, is a strong motive for almost superhuman 
exertion. We see this almost daily in the lower strata of 
civilized nations where people without the comfort of 
religion and philosophical resignation, stand in perfect 
terror of death, and would rather suffer any privations 
fhan submit to the inevitable. How much more horrify- 



202 HEALTH AND SOCIAL PROGRESS 

ing must this calamity have appeared to man after he had 
peopled the world with all sorts of evil spirits, and had 
no way of reconciling himself to his fate by the comforts 
of a more rational view of the world ? Life was hard, but 
death was terrible! And so he struggled with all his 
power to postpone the evil day. The best way to do that 
was to seek more healthful regions. 

We need not assume that the discovery of the possi- 
bility for a longer life was made suddenly. It came like 
all other discoveries and inventions gradually and acci- 
dentally. The man who had wandered into the hills in 
search of food or in stalking game must have felt the 
exhilaration of a purer atmosphere and the beneficent 
effect of the absence of at least some insect pests. Man 
was teachable, and he deliberately repeated the experi- 
ence. In the course of time he formed a dim and crude 
notion about this matter, and the most enterprising men 
must sooner or later have gone in search for such locali- 
ties. These men were naturally the strongest, since they 
alone could undergo the hardships of even moderately 
distant travel. In these localities they gained better 
health and greater strength, and perhaps began to prey 
upon the people in the valleys. Owing to the plasticity 
of early man, new stocks with greater vitality and men- 
tality were soon formed, and both became incentives to 
further exercise of physical and mental faculties, since 
good health with surplus energy craves for an outlet. 
The weaker members were left in the less wholesome 
regions, as is the case today, and as brought out so strik- 
ingly by Miss Semple in the passage quoted above con- 
cerning Peru, Bolivia, and Ecuador. Little or no prog- 
ress was possible under these conditions, and the typical 
" deadly climates " have always been the abode of devi- 
talized and uncivilized peoples. The migrants, on the 



HEALTH AND WORLD-PROGRESS 203 

other hand, traveled on, always leaving the weaklings be- 
hind in what seemed to the latter favorable places for 
settlement ; they separated and traveled in different direc- 
tions, driven partly by genuine Wanderlust, and partly 
by the desire to match their wits and courage against new 
difficulties. In the course of time these groups became 
estranged, changed, and when their descendants met after 
thousands of years in entirely new countries they fought 
each other for the best localities in which to make a 
living; but the battle always went to the strongest, i.e., 
the healthiest. The peoples of the mountains or from 
comparatively disease-free plains always subjugated those 
in the less salubrious but more fertile plains, and the 
contact between two different stocks generally had a 
deepening and broadening effect upon the minds so that 
new civilizations sprang up here and there in the tropics 
and sub-tropics. All of them were, however, local and 
ephemeral, since the healthful areas were nowhere of 
sufficient extent to enable a large number of people to 
exchange ideas, and since the small number of conquerors 
subjugating a large population in less sanitary but more 
fertile regions invariably succumbed sooner or later to 
the endemic diseases, leaving the natives with a culture 
which they were unable to maintain long, because of their 
inherent physical and mental weakness. We must come 
back, therefore, to our problem of the civilization pro- 
duced by the white race and more particularly by the 
Baltic or Teutonic stock, since this alone has had con- 
tinuity of progress and sufficient extension to mature 
into a truly high and world-wide culture. 

In the Mediterranean countries we have for the first 
time a combination of circumstances which made a con- 
tinuity of progress possible and permitted a sufficient 
extension of civilization to insure the contact of numerous 



•I., 



304 HEALTH AND SOCIAL PROGRESS 

and varied races and stocks. An independent civilization 
sprang up in Mesopotamia and another in Egypt; both 
were located in fertile river valleys, and both were the 
result of strong and healthy races coming in contact with 
peoples who had, under the influence of favorable 
climates, built up a fair material culture. The native 
races were unable to rise above the level of economic 
considerations, and only the more virile races who came 
from northern countries could add a touch of something 
more spiritual to this culture by art, religion, and phi- 
losophy. When the invaders succumbed to the endemic 
diseases, a relapse into a lower condition invariably re- 
sulted, and only a new set of conquerors from a dif- 
ferent country could take up the thread and spin it fur- 
ther. For Egypt has been ruled by foreigners from time 
immemorial to the present day. Fortimately, the inter- 
regnum was never too long, and the new dynasty could 
always begin at least somewhere near the plane where its 
predecessors left oflF. Some of these dynasties conquered 
other countries, both south and northeast, and thus the 
Mesopotamian and Egyptian civilizations came in contact 
with each other. A conquest of Nineveh by Amenophis 
II is reported as early as 1566 B.C.; and from that time 
on the intercourse between the two countries was almost 
continuous, owing to the fact that both countries strove 
for the mastery of Syria and Palestine, until Essar- 
haddon of Assyria captured Egypt about 671 B.C. An 
important civilization had also developed in the island 
of Crete ; and the rivalries between Egypt and Mesopo- 
tamia gave the Phoenicians an opportunity to create a 
dominant power along the Mediterranean, not so much 
by conquest as by commerce. Greece and Italy must 
have been affected by these movements, and if the theory 
of Baltic immigration should be based on fact, these 



HEALTH AND WORLD-PROGRESS 205 

blonds would have found a civilization well advanced and 
of a sufficiently high and varied character to fertilize the 
minds of a vigorous race. Thus Greek and Roman cul- 
ture developed on the basis of all those produced by the 
peoples along the Mediterranean. As these two peoples 
of apparently Baltic stock perished through their lack 
of racial training against malaria and, most probably, 
uncinariasis, their civilization dropped to lower levels, 
since the disease-ridden but acclimated natives of these 
countries could not raise civilization beyond a certain 
plane without the assistance of a more vigorous race that 
had accumulated a vast store of vitality in healthful 
countries. 

From the fall of the Roman Empire at the hands of 
later Teuton invaders — all of whom shortly perished of 
these prevalent diseases— to the present time, civilization 
has gradually moved northward, first to Florence, Milan, 
and Venice, then to France, Germany, England, Den- 
mark, and Scandinavia. While Italy is still prominent 
in art, Denmark has developed remarkably in that respect, 
and Scandinavians are becoming more prominent as 
writers of really important literature. The Latin na- 
tions, notably France and Italy, may be able to hold 
their place as teachers of the fine arts owing to the vast 
accumulations of classical remains in their museums, but 
the science and art of producing and distributing wealth 
and creating welfare among the masses, are now taught 
by Teuton countries. The Scandinavians, the Germans, 
the English with their colonies, and the Americans, are 
now leading the world in all matters pertaining to social 
well-being, and are likely to keep the lead for a long 
time over the Latins, since they are not handicapped by 
fighting a constant foe to their vitality. Italy and Greece 
may be able to avert the worst forms of devitalization by 



206 HEALTH AND SOCIAL PROGRESS 

the application of modern scientific methods, but that 
costs money which the other countries are able to apply 
to productive uses. " Ricchi calculates that the Adriatic 
Railway Company alone, for 1.400 kilometers of rail- 
way and for 6,416 workmen in the malarial zones, spends 
on account of malaria the enormous sum of 1,050,000 
francs a year." "* This disease and its eventual eradica- 
tion will cost Italy and Greece enormous sums, and even 
then the battle will only half be won, since it will take 
many years before the depleted constitutions can be 
brought up to the normal so as to produce balanced brains 
and bodies. 



We have come to the end of our review of civilization 
as affected by health. European culture has become pos- 
sible on account of its continuity of progress and ex- 
tension. Around the Mediterranean alone were there 
extensive areas where civilization could rise to com- 
paratively high levels owing to better sanitary conditions 
than are found in the tropics and sub-tropics. There 
alone are different races found which assured not only 
numerous but varied contacts so as to stimulate the mind. 
There alone we find an almost continuous influx of 
healthier and stronger northern races which respond 
readily to the stimuli of more favorable conditions than 
they had in their native habitats. A continuity of prog- 
ress was thus made possible, and a gradual movement of 
civilization further north toward the regions which are 
practically free from endemic diseases. The races living 
there enjoy good health and have strong vitality. The 
average duration of life in Sweden is 50.9 years for 
males and 53.6 for females; in Denmark 50.2 and 53.2; 
in France, the country with the next highest records, 45.7 



HEALTH AND WORLD-PROGRESS 207 

and 49.1 ; in England and Wales, 44.1 and 47.7 ; in Massa- 
chusetts 44.1 and 46.6; in Italy, 42.8 and 43.1 ; in Prussia 
41.0 and 44.5; in India, 23.0 and 24.0, respectively."* 
These figures are a proof of the strong vitality of the 
Scandinavians, with an average longer life of 8 years 
for males and more than 10 years for females as com- 
pared with Italy. This fact will assure the continuity 
and permanence of civilization, since the neighboring 
countries are likewise healthful and are productive of 
high vitality. These races are, moreover, spreading over 
the whole globe, and willingly adopt anything advanta- 
geous to themselves and transmit it to others. World 
commerce — ^now almost entirely in the hands of the Baltic 
race — ^brings about the most numerous and varied con- 
tacts between all races, and stagnation is thus precluded 
for a long time to come. All the conditions for a perma- 
nent and world-wide civilization are meeting now for the 
first time in the history of mankind, and science is just 
beginning to study and improve them with the purpose 
of conveying these benefits to all peoples. 



CHAPTER XII 



HEALTH AND WORLD-PROGRESS (Concluded) 

Is civilization always to be precarious, as it has been 
in the past? Or is it always to be looked upon as the 
result of degeneration, as it is by some at the present 
time, on the basis of the philosophy popularized by J. J. 
Rousseau and Cesare Lombroso? If so, the present in- 
tensity of the struggle for a higher life and for a more 
general spread of civilization ought to be discounte- 
nanced ; since, if bringing knowledge to the poor only in- 
creases their misery, and if giving culture to nature- 
peoples only dooms them to extinction, our endeavor in 
scattering the fruits of European achievements over the 
globe would be nothing short of criminal. It would 
justify the claims of those who say that civilization is a 
curse and the only life worth living is that of nature in 
its unadorned state. 

It cannot be denied that many nature-peoples have 
become extinct, because rapacity on the part of the com- 
mercial and political exploiters took the best they had 
and gave them the worst in return ; and our ignorance of 
tropical endemic diseases prevented the possibility of our 
rendering aid to them in the only manner where assistance 
was of real importance. A change is, however, beginning 
to come into our policies toward the peoples of the 
tropics. It is becoming recognized that the world needs 
them, and that it is necessary to have them in good health, 
so that beside the happiness which will come to the people 
themselves, they will be able to produce the various kinds 

208 



HEALTH AND WORLD-PROGRESS 209 

of food which only a warm climate can produce. In the 
past men from the north had to go south and settle there 
if they wanted to enjoy those products. The result was 
always the same— decay and extinction. A later policy 
of exploitation became possible with better means of 
transportation. This has likewise been recognized as 
being unwise, for if the people inhabiting the tropics 
should become extinct, who would raise those products 
which we need to an ever-increasing extent? For even 
with our knowledge of how to cure tropical diseases, 
men from the north will not be ready for some centuries 
to settle permanently in warm countries, since it is one 
tiling to endure a climate and quite another to thrive in 
it It is, therefore, necessary for civilized peoples to 
form a sound and coherent policy in regard to the tropics, 
if their culture is to extend and encircle the globe so as 
to benefit all. 

The precariousness of civilization in the past as dis- 
cussed in previous chapters, was due mainly to two 
reasons — the small areas of the isles of health, and the 
extinction of the migrants from the north in lower lati- 
tudes. Thus neither a large extent nor continuity of 
culture was possible, and it could never rise to a high 
level. A third reason may now be added — the impossi- 
bility of maintaining large cities in a sanitary condition 
for a long time. 

3. Unsanitary Condition of Cities. In the past the 
city has always been a devourer of people from the 
country. Hardly any of the city families prospered be- 
yond the third generation. " If the conditions in city life 
generally or in a given city are conducive to human 
mortality, it .nay well be that city life generally or the 
life of some city in particular, may be of such a bad char- 
acter that the death rate is higher than the birth rate. If 



210 HEALTH AND SOCIAL PROGRESS 

that is the case the city is dependent upon migration to 
It, not only for its increase in population but as well for 
its continued existence as a city. 

" We may say that this was the condition of most 
cities in the European world prior to the opening of the 
nineteenth century. Thus it is said that in London in the 
forty years from 1603-44 there were 363,935 burials 
and 330,747 christenings. A German student who inves- 
tigated the church records of baptisms and burials in 
several German cities came to the conclusion that on the 
average there were eighty or ninety births to one hundred 
deaths m the period from 1550-1750." "* 

Through better sanitation and greater medical skill 
cities have constantly reduced their death rate during the 
nineteenth century, so that they themselves are furnishing 
from one-fourth to one-half of the increase in their 
population in Sweden and Germany and about three- 
quarters of their increase in Great Britain. In 1900 the 
mortality of the United States per 1,000 was 15.4 in 
rural districts and 18.6 in urban. Since that time the 
death rate has been reduced still further, so that New 
York City, for instance, has had an excellent record with 
16 deaths per 1,000 in 1909; 15.98 in 1910; 15.13 in 1911 • 
14.11 in 1912, and 13.77 in 1913. Other large cities have 
similar small death rates; e.g., Chicago in 1912, 14 68* 
Paris, 16.38; Berlin, 14.39; London, 13.52. With in- 
creased knowledge of hygiene and dietetics, better sanita- 
tion and greater medical skill, the cities may eventually 
be able to balance their death and birth rates. In any 
event, no civilized city will ever share the fate of many 
ancient cities of becoming a ruin after a few hundreds 
of years, because of plagues and other diseases arising 
from filth and dirt. No such spectacle will be offered 
to future generations concerning Paris and London as 



HEALTH AND WORLD-PROGRESS 211 

we have of Troy and Babylon, where we find several 
cities buried one under the other. These modem cities 
may fall some time, but not on account of devastating 
diseases, and Macaulay's famed traveler from New Zea- 
land may have to wait some thousands of years before 
he can view the ruins of the imperial city from London 

bridge. 

The significance of the city for civilization lies chiefly 
in the fact that there contacts between human beings 
are both numerous and varied — one of the essentials of 
high mental development. In the past as well as today, 
the cities have generally produced or at least harbored 
the most intelligent men. Men of ability and ambition 
have always sought in the urban centers the larger op- 
portunities for meeting people with gifts different from 
their own. Because of the unsanitary conditions in the 
cities of the past, these men often fell victims to various 
diseases and were hardly ever able to give their children 
strong constitutions, so that mankind could not benefit 
from generations of well-born sons and daughters de- 
scended from famous men. Hence most of the good 
stock ended with its most prominent member, or the 
offspring was decidedly inferior. The city thus epito- 
mizes the two conditions discussed above. Owing to poor 
conditions of health, cities in the past could never be 
large ; contacts were, consequently, always comparatively 
few and similar. For the same reason cities could never 
have a long life, and continuity was impossible. As the 
southern plains and valleys attracted the more healthy 
men from the hills or from the north only to produce an 
efflorescence of civilization before their inevitable decay 
commenced, so the cities enticed the most capable men 
into their walls where greater opporttmities offered every 
facility for a higher mental development but undermined 



212 HEALTH AND SOCIAL PROGRESS 

their vitality. Under these conditions an extensive and 
continued civilization was impossible. 

At present, cities are not only improving their sanitary 
conditions and thus insuring their continuity, but they 
are becoming constantly larger and furnish better oppor- 
tunities for more numerous and varied contacts. Accord- 
ing to the census of 1910 our urban communities con- 
tained 46.3 per cent of the total population, and incor- 
porated places of less than 2,500 inhabitants 8.8 per cent, 
making 55.1 per cent residing under conditions more or 
less urban in character. And the cities are attracting not 
only the stronger elements from the country districts, 
but the better class of the foreigners. The urban com- 
munities had 72.2 per cent of the foreign bom, 65.3 per 
cent of those of foreign or mixed parentage, and only 
27.4 per cent of the negroes; while the rural communi- 
ties had 27.8 per cent, 34.7 per cent, and 72.6 per cent 
of these elements, respectively. Whatever one may think 
about foreigners locating in cities, they furnish at least 
many incentives for thought, and often reveal remarkable 
ability under the stimulating influences of urban life. 
Civilization is thus likely to rise higher and spread 
farther, since the cities are more directly in contact with 
every corner of the globe through improved methods of 
communication, and attract the most ambitious and capa- 
ble men from everywhere. 

It is perhaps due to this fact that not only has civiliza- 
tion taken tremendous strides during the nineteenth cen- 
tury, but that cities have developed phenomenally during 
that period. No reference need be made here to Ameri- 
can cities, since their rapid growth is well known ; but a 
few statistics concerning some of the older cities may 
serve to illustrate this point. " London is probably two 
thousand years old, and yet four-fifths of its growth 



HEALTH AND WORLD-PROGRESS 213 

was added during the past century. From 1850 to 1890 
Berlin grew more rapidly than New York. Paris is now 
five times as large as it was in 1800. Rome has increased 
50 per cent since 1890. St. Petersburg has increased 
fivefold in a hundred years. Odessa is a thousand years 
old, but nineteen-twentieths of its population were added 
during the nineteenth century. Bombay grew from 150,- 
000 to 821,000 from 1800 to 1890. Tokio increased 
nearly 800,000 during the last twenty years of the cen- 
tury ; while Asaka was nearly four times as large in 1903 
as in 1872, and Cairo has more than doubled since 1850. 
Thus, in Europe, Asia, and Africa we find that a redis- 
tribution of population is taking place, a movement from 
country to city. It is a world-phenomenon." *^* And so, 
also, is civilization becoming world-wide. The growth 
of cities and the extension of at least material if not 
cultural civilization, are inextricably intertwined; and 
with the health of the city the continuity and extension of 
culture is assured. We have solved the problem of the 
precariousness of civilization. 

Will it be possible to extend it to lower latitudes? In 
order to answer this question it may be best to refer to 
what has already been accomplished in those regions. 
The Panama Canal Zone was known for centuries as 
one of the worst breeders of disease, and the French were 
unable to build the canal because of this fact. They 
not only lost $260,000,000 in this fruitless endeavor, but 
buried over 22,000 men with an average working force 
of 10,200 in that failure. Their death rate was 240 per 
1.000 during the eight years of work. 1881 to 1889. Under 
American management the total death rate among the 
employees of the Isthmian Canal Commission and the 
Panama Railroad Company for the calendar years since 
work began has been as follows : 1904, 13.26; 1905, 25.86; 



214 HEALTH AND SOCIAL PROGRESS 

1906, 41.73; 1907, 28.74; 1908, 13.01 ; 1909, 10.64; 1910, 
10.98; 1911, 11.02; 1912, 9.18. The malaria morbidity 
per 10,000 was 821 in 1906 ; 426 in 1907 ; 282 in 1908 ; 215 
in 1909; 187 in 1910; 184 in 1911 ; 110 in 1912, and 76 
in 1913. Meanwhile the number of employees increased 
from 82 in 1904 to 50,893 in 1912 ; and 38,340 of these 
were blacks from the West Indies and other sub-tropical 
countries where cleanliness is rarely a habit of the colored 
population. This increased the difficulties of fighting 
disease, as may be shown by the fact that the death rate 
from disease for whites from the United States was only 
3.25, and that of white employees generally 4.62, as 
against 6.94 for colored employees. The white em- 
ployees were, moreover, in many cases Spaniards, 
Italians, and Cubans, and were not of a particularly moral 
type, as may be inferred from the fact that of 101 deaths 
from all causes among them in 1912, 43 were due to 
violence over against 58 to disease. The death rate for 
the total population of the Canal Zone has decreased from 
49.94 in 1905 to 20.49 in 1912 per thousand."^ Thus we 
have a material reduction in the death rate from disease 
in a region which has always been considered a pest 
hole, and with a population which was not by any 
means the most promising for an experiment of this 
kind. 

The Panama Zone is, moreover, not the only place 
where results of this kind have been won. Malaria ap- 
peared, for the first time at Ismailia in 1877. From 
August to December there were 300 cases out of a popu- 
lation of 10,000. By 1891 nearly 2,500 cases were re- 
ported. The town fell into decadence and the govern- 
ment offices were moved. With a population of about 
6,000, there were 2,250 cases of malaria in 1900, 1,990 in 
1901, and 1,548 in 1902, when drainage works were estab- 



HEALTH AND WORLD-PROGRESS 215 

lished; the beneficent effects of these were seen in the 
reduction of malaria cases to 214 in 1903, to 90 in 1904, 
and to 37 in 1905. Klang and Port Swettenham, con- 
tiguous towns in the Federated Malay States, with a 
population of about 4,000 and an annual rainfall of 100 
inches, obtained similar results. They had 510 cases of 
malaria in 1900 and the number was gradually reduced 
to 23 in 1905. Hong Kong reduced its number 
of malaria cases from 1,294 in 1901 to 419 in 
1905."« 

Italy offers a most interesting study in this respect. 
The annual mortality from malaria used to be about 
15,000, representing about 2,000,000 cases of sickness. 
In 1902 a State monopoly for quinine was established to 
insure the purity of this medicine at a reasonable price. 
The result may be seen from the following figures; 
1901-02 the deaths from malaria numbered 13,358. In 
1902-03, the year following the State monopoly, 4,932 
pounds of quinine were sold and the deaths numbered 
9,908; as the use of pure quinine increased, the num- 
ber of deaths decreased, until in 1906-07 we have with 
the consumption of 45,591 pounds of quinine only 4,875 
deaths from malaria. Incidentally the government made a 
profit of 41,759 pounds sterling during these five years.*** 
Many other cases, covering widely different localities in 
the tropics and elsewhere, might be mentioned; but they 
would merely illustrate the same point.* 

The objection may be raised that these results were 
gained at too high a cost to make the remedy generally 
applicable in the tropics and sub-tropics. That is, how- 
ever, not the case. At Ismailia the initial costs of opera- 

*See The Prevention of Malaria, by Ronald Ross (with 
contributions by many physicians) ; E. P. Dutton & Co., New 
York, 1910, pp. 369-575. 



v^\ 



216 HEALTH AND SOCIAL PROGRESS 

tion were 625 francs, and the annual expenditure for 
maintenance about 2.3 francs per head of the population. 
Klang expended 3,100 pounds sterling for clearing 332 
acres of swamp, and about 270 pounds annually in the 
campaign for health; Port Swettenham spent 7,000 
pounds sterling for clearing 110 acres, and about 240 
pounds per year for upkeep. The cost of the sanitary 
provisions at Panama are variously estimated. A member 
of the Isthmian Canal Commission, Mr. H. H. Rousseau, 
estimates the total expenses of the Sanitary Department 
at $2,000,000 per annum, with more than 1,200 men on its 
pay roll and including both the curative and preventive 
work. The total cost of this department may be about 
$20,000,000 including sanitation, quarantine, and all pos- 
sible prophylactic measures. That amounts to about 
five per cent of the total cost of the Canal. This is 
certainly a reasonable expenditure when we recall that 
yellow fever was frequent prior to the beginning of this 
work and that as late as 1904 about 75 per cent of the 
people in the Zone were infected by malaria."® Figur- 
ing $2,000,000 per year and an average of 50,000 em- 
ployees for the last five years — although it was some- 
what smaller — the cost per man per day would be some- 
what over ten cents, or about $40 per year. Dr. J. S. 
Lankford claims that the purely preventive work 
averaged one cent per day per man, and maintains that 
this investment was responsible for the low mortality 
and morbidity rates."* General Gorgas himself, in a 
paper read before the American Society of Tropical 
Medicine, in June, 1910, estimated the cost per capita per 
day at two and one-half cents for medical and hospital 
treatment, and for sanitation alone at only nine mills 
per day.'" 
The reason why the estimates of cost of the sanitary. 



HEALTH AND WORLD-PROGRESS 217 

medical, and preventive work at Panama differ so widely 
is the complicated bookkeeping of the government. Gen- 
eral Gorgas gives two cases as illustrations.* When the 
President of Panama died the medical department was 
ordered to embalm the body. The expenses — about $100 
— were charged to that department, but the refund from 
the family, amounting to more than the costs — was 
credited to engineering and construction. Similarly the 
expenses for certain patients in the hospitals — about $30,- 
000 — were charged to sanitation; but the receipts of the 
Commission from them — about $50,000 — were credited 
to construction and engineering. 

The expenditures cited are well within the financial 
ability of any tropical country when its resources are even 
moderately developed. It is true, of course, that financial 
considerations were not of primary importance in the 
vast majority of cases where work of this kind was 
undertaken. For administrative reasons something had 
to be done to reduce the appalling morbidity and mortality 
rates, no matter what the costs might be. It has proved, 
nevertheless, to be good business. 

General Gorgas figures f that if the mortality rate of 
the workers under the American regime had been that 
under the French, there would have been 78,000 deaths 
during the ten years the Panama Canal was building in- 
stead of the 6,630 which actually occurred with an 
average working force of 39,000. It is a question 
whether the people of our country would have been will- 
ing to have the canal built under these conditions. The 
sanitary and medical work saved the Canal Commission 
in direct cost $39,420,000 by preventing 39,420,000 days 

* Sanitation in Panama, by William Crawford Gorgas; D. 
Appleton & Co., New York, 191 5, PP- 239 and 242. 
iOp. cit., p. 283. 



218 HEALTH AND SOCIAL PROGRESS 

of sickness among the workers. The indirect saving 
was, of course, much greater. 

It may be in place here to point out that this work of 
making the tropics endurable for men from higher lati- 
tudes has become possible only within the last twenty 
years ; that is, since the discovery of one species of mos- 
quito as the carrier of malaria, of another species as that 
of yellow fever, and of the discovery of the hookworm, 
coincident with the cause and cure of other tropical 
diseases. So no matter how skillful De Lesseps may have 
been as an engineer, he could not have completed the 
Canal without sacrificing many more hecatombs of men 
to diseases at Panama. The cost in lives would literally 
have staggered humanity. If we consider that medical 
men are just beginning to devote special attention to 
tropical diseases and that remarkable results have been 
achieved within a short time, the auguries for the future 
are certainly propitious. We may, therefore, expect to 
accomplish many things in this direction, deemed impos- 
sible at present. 

It will become more necessary as time goes on to 
investigate these matters and to find means for mak- 
ing the tropics more habitable; that is, more fit for 
the whites to live in and for the colored to work in, 
since the human race is becoming increasingly de- 
pendent on the warm countries for a large part 
of its food supply. This is due to two facts — in- 
crease of population, and greater need for a varied 
diet. 

The rapid increase of the world's population may be 
seen from the following figures. The World's Almanac 
for 1903 states that the population of the Roman world 
at the time of Emperor Augustus was only 54,000,000, 
notwithstanding great density existing in some spots. By 



HEALTH AND WORLD-PROGRESS 219 

1810 it had increased to only 682,000,000 and by 1905 
to about 1,600,000,000. This tremendous increase in the 
last century was due to various causes; e.g., discovery 
of new lands which furnished an enormous food supply, 
reduction of mortality by means of better sanitation, 
greater medical skill, fewer wars, and greater comforts. 
The earth is far from being overpopulated, since Raven- 
stein estimates it could support 207 people per square 
mile with present methods of production, whereas the 
present density is much below that, e.g., 14.71 for Africa, 
13.42 for North America, 5.19 for South America, 59.05 
for Asia, 111.32 for Europe, and 12.2 for Oceania, mak- 
ing an average of 33.50 per square mile for the world. 
True, only about 28,269,200 square miles of the world's 
area (49,668,000 square miles) are reputed as fertile, 
while 4,888,800 square miles are taken up by the polar 
regions, 4,180,000 square miles by deserts, and 13,901,000 
square miles by steppes. This means that the area for 
the polar regions has to be deducted from the total area 
capable of supporting any people and we may even deduct 
the deserts for the present. The steppes, however, will 
in the course of time become habitable, since we are find- 
ing means to make them yield an ample food supply 
through irrigation, dry farming, and specially adapted 
crops. In the United States alone about 75,000,000 acres 
may be made available through irrigation and at least 
50,000,000 through dry farming. We are also trying 
to drain the 100,000,000 acres of swamps within our 
own territory — the most fertile land, by the way — ^in 
order to support a larger population. It has been esti- 
mated that the swamp, desert, and arid land in the United 
States could well support about 100,000,000 people. 
Nevertheless, if the population increases at the ratio of 
even one hundred per cent in a century instead of nearly 



I "ti 



220 HEALTH AND SOCIAL PROGRESS 

three hundred as in the nineteenth century, the food 
supply will become insufficient in a few hundred years, 
and a larger demand will have to be made on the tropics 
for additional food, notwithstanding all possible increase 
from additional lands recovered and from more scientific 
cultivation. The tropics have an almost unlimited capac- 
ity for increasing our food supply if properly tilled, owing 
to the much larger amount of heat the land gets from the 
sun. The land which can grow two, thrre, or even four 
crops a year of different food products, will and must 
play a large role in the economy of the world when the 
population has grown to four or five times its present 
niunber. 

A greater variety of food will likewise demand that 
the tropics and sub-tropics be made habitable. The finer 
the human organism becomes, the greater the variety of 
food it needs. Primitive man might live on uncooked 
herbs, roots, and nuts, and perhaps occasional raw meat ; 
but what was his brain? Very little above that of the 
animals which fed on the same products of nature. Only 
by better and more regular meals was man able to develop 
a better nervous system with its greater power of coordi- 
nation and combination. The savage whose ability to 
count only up to three, and who has to make e.g., thirty- 
three payments for ninety-nine sheep, that is, for each 
three sheep separately, may be a human being with 
untold capacities ; but as a plain matter of fact his abilities 
have not been developed, and he is far removed in power 
of combination from the modern business man for whom 
a few millions are a mere trifle. This difference in power 
of coordination may be illustrated even within historic 
times. 

The greatest business man of antiquity was perhaps 
Job, with his 7,000 sheep, 3,000 camels, 500 yoke of oxen, 



HEALTH AND WORLD-PROGRESS 221 

500 she-asses, and a very great household; so that this 
man was the greatest of all the men in the East, according 
to the Old Testament. He had, moreover, the ability 
to double his whole fortune after the loss of everything 
but his perfect and upright character. But what is he in 
comparison with a modern trust magnate who controls 
vast natural resources, numerous railroads, banks, fac- 
tories, even restaurants — with all their ramifications in 
civilized and even uncivilized countries? He could buy 
out Job with a month's profits, or more likely those of a 
week. And he may be equally perfect and upright in 
character. 

Take another illustration from a different field of 
human enterprise. Alexander the Great overran all the 
countries of the Mediterranean in a few years with about 
30,000 soldiers. He had them under his eyes practically 
all the time, and could instantly take measures to meet 
the emergencies of a battle. In the late Russo-Japanese 
War, Field Marshal Yamagata had a battle line usually 
300 miles in length, at times 500 miles ; the details to be 
attended to were complex and numerous, as there was a 
constant shifting of positions, while aides-de-camp, tele- 
graphs, and telephones brought messages continually. Or 
take Field Marshal von Moltke in the Franco- Prussian 
War of 1870-71, who had prepared his plans before- 
hand, and carried them out in a hostile country with 
clock-work precision. During the recent European war 
the powers of coordination had to be larger still, with 
war-fronts of over 1,000 miles, all the modem means of 
communication, and armies of millions demanding atten- 
tion. 

What an infinitely larger power of coordination over 
varied and numerous factors is necessary in all these 
owes compared to the very simple affairs of antiquity! 



222 HEALTH AND SOCIAL PROGRESS 

In speaking of the comparative mental capacity of the 
ancients and the moderns we generally look at subjective 
achievements, that is, those in art, literature, and philoso- 
phy; and since they excelled us along these lines, we 
hastily conclude that they were men of a superior race. 
We forget, however, that there are giants in our own 
days, but in different lines of activity. We have those 
giants, too; compare a Michelangelo in art, a Shake- 
speare in drama, a Kant or a Hegel with Socrates or 
Plato. But in activities requiring a large power of coordi- 
nation, we are head and shoulders above the Greeks or 
Romans. Even in comparatively abstract matters we 
excel them. Aristotle is a pigmy beside Herbert Spencer, 
and the former is justly charged with imperturbable 
dogmatism, owing to his ignorance of the limitations of 
his own knowledge. Spencer may be dogmatic at times ; 
but his range of knowledge is infinitely broader than 
that of the Greek sage, and his power of coordinating a 
vast amount of information is very much higher, while 
he rarely believes his own propositions to be final. Com- 
parisons in other fields might be made in favor of the 
moderns, but the few examples given will serve to show 
that civilization is not retrograding and that man of the 
twentieth century a.d. is at least the equal of the man 
of the fifth century b.c. If civilization is measured 
by the distance between the agent and the place of 
action, we have certainly advanced since the times of 
Pericles. 

How did man acquire a better nervous system ? Briefly 
stated, by better food, better housing and clothing, and 
more regular work and exercise. Food serves three pur- 
poses — health, pleasure, and economy; and all three are 
now met in a better way than ever before. We eat 
regularly and therefore rarely overload the digestive 



HEALTH AND WORLD-PROGRESS 223 

organs, as the savage frequently does owing to periods 
of starvation. Our food is on the whole nourishing and 
well prepared, and we need, consequently, a smaller 
amount of it, unlike the nature-peoples, who often eat 
enormous quantities of poor food in order to satisfy their 
craving for nourishment. Improved housing and cloth- 
ing insure a more even temperature of the blood without 
drawing too much on vitality which is necessary for other 
purposes. The Eskimo, for instance, needs a vast amount 
of fats merely to maintain a proper temperature of the 
blood, and a good deal of energy is consumed in this 
process, which otherwise might go into the building up 
of a better nervous system through improved digestion 
and a more varied diet. More regular work and exercise, 
possible only on the basis of the two conditions just men- 
tioned, likewise contribute to the growth of a better 
nervous system. Any organ will develop more perfectly 
if it has regular, constant work and exercise, since dif- 
ferentiations of finer organs are possible only on that 
basis. The fortuitous " sports " may have had a role to 
play in evolution, but little dependence can be placed on 
them; since of necessity they appear very irregularly, 
and systematic development cannot take place that way. 
The only thing which will, at least in human society, 
bring about progress, is regularity of work. And that is 
possible only with good health as the basis of a finer 
nervous system. Good health is, however, dependent not 
only on regularity of food consumption, better housing 
and clothing, and regular exercise, but on a more varied 
diet. That brings us back to the tropics from a new 
point of view. 

Even if man in high latitudes had sufficient food of 
the kind produced in his own climate, history proves that 
he developed higher capacities only when he came further 



224 HEALTH AND SOCIAL PROGRESS 

south, or when the south was, figuratively speaking, 
brought north. In other words, the foods produced in 
the north could produce in combination with other favor- 
able factors prevailing there, a strong physique and a 
strong brain, but not a fine nervous system and brain. 
The digestive organs were too much burdened, for in- 
stance, with the assimilation of starch in northern lati- 
tudes, and the nerve fiber could not become as fine as that 
which was nourished on sugar. When these healthy, 
large-boned, and muscular men from northern climates 
came south, they found this very substitute for starch in 
the sugar of grapes, figs, dates, honey, and other products 
of warmer climates. This was a great economy for the 
digestive organs, and a larger surplus of energy was 
created, which went into the growth of a finer nervous 
system, since it was not needed for meeting additional 
expenditure in the struggle for existence, owing to the 
reduction of the native population to the condition of 
slaves, and the consequent leisure of the conquerors. 
What is true of sugar may apply to other products of 
warmer climates, which serve a necessary purpose in our 
physical make-up, but can be had in the north only in a 
roundabout way through heavier and less digestible foods. 
Man's remote ancestor was able to digest cellulose, as the 
camel and the goat are doing now; but he could not 
develop much mentality, since the process of digestion 
required too much energy. Later he secured starch in- 
stead of cellulose from fruits and grains, and the diges- 
tive organs were relieved of a large amount of work with 
a consequent higher possible development of mind. Still 
later, he consumed sugar from southern fruits, and re- 
lieved his digestive organs still more, with a consequent 
higher possibility of producing a finer brain. Thus there 
is a constant saving of energy in the process of digestion 



HEALTH AND WORLD-PROGRESS ! 225 

from cellulose to raw, and later, cooked starch, and even- 
tually to sugar, for physiologists have shown that carbo- 
hydrates are presented to the cells in the form of a 
sugar, both in plants and animals. If a similar saving 
is taking place with other foods obtainable in the south, 
we can readily understand why the people from the 
north when coming south were able to have an efflores- 
cence of a mental life unknown to them before, especially 
as this saving in energy was accompanied by contact with 
a new civilization. Their diet, chiefly nitrogenous in the 
north and creative of initiative, was supplemented in 
many ways by the lighter foods of the south, and a more 
economical and more satisfactory nourishment of the 
body was possible, while social conditions suggested new 
avenues for discharging their increased vitality and men- 
tality. This advancement continued, however, only a few 
centuries, as we have seen before, owing to the endemic 
diseases prevalent in these countries, and the civiliza- 
tions thus created fell into decay. The natives of 
the warmer countries lacked nitrogenous food as a 
rule, and this circumstance, combined with the gen- 
eral low sanitary conditions discussed in previous 
chapters, prevented them from developing a higher 
mentality. 

With the development of more rapid and frequent 
transportation another solution has been found— to bring 
the south to the north by importing the products of 
warmer climates. The imports of tropical and sub-tropi- 
cal products into northern countries of Europe and 
America has increased very considerably during the last 
30 years. The Statistical Abstracts of the United States 
for 1912 (p. 557) and for 1916 (p. 519) give the follow- 
mg figures for the import of tropical products into this 
country : 



226 HEALTH AND SOCIAL PROGRESS' 



Year 1885 

Spices 22,124,757 lbs. 

Supr 2,717,875.412 " 

Tobacco leaf. 12,924,265 * 

5>« 119,740,577 " 

Tea 72,104,956 " 

Cocoa 10,300,112 *' 

Coffee 572,599,552 " 

Cotton 5,115,680 " 

India Rubber 24,208,148 " 

Jn^igo 3.034,650 " 

Licorice Root 27406,008 " 

Olive Oil.... 493.929 gall. 

^"K 3424,076 lbs. 



Year 1912 

63,116,548 lbs. 
5,998,930,550 '* 
57.740,838 " 
194.737,948 " 
111,406,816 ** 
145.968,945 " 
887,747,823 " 
144,490,745 " 
125,656,386 " 
7.658.067 " 
78,582.225 '' 
5,472,528 gall. 
26,584,962 lbs. 



Year 1916 
82,880,337 lbs. 
7,618,196,085 " 
54,732,098 " 
267,965,948 " 
109,865,935 
243.231,939 
1,203,866,007 

233,135,696 

304,182,814 " 

6,599,583 " 

41,003,295 " 

8.109,375 gall. 
41,925,297 lbs. 



it 
*• 

(( 



These imports are not luxuries, as the moralists, ad- 
vocates of the "simple life" and of the "return to 
nature," would have us believe ; they are absolute neces- 
sities of a higher physical and mental organization. Meat 
eaters may have strength and initiative, but they become 
nervous; vegetarians have endurance for mere physical 
toil, but consume too much energy in the process of 
digestion to develop self-reliance and originality. " Not 
only does health of body and mind depend upon the food, 
but it is built up from childhood, and appears to be re- 
sponsible for the making of man what he is—the most 
advanced creation of the animal world. While man has 
attained this station by virtue of his intelligence, we 
shall show later on that this intelligence, too, depends 
upon his food. As a matter of fact, we find that where- 
ever man is restricted to a sparse, one-sided and incom- 
plete diet, (and that of most animals is of this nature) 
as are the inhabitants of many of the southern islands 
and the Bushmen, his intelligence is likewise of the 
lowest order. Thus, the ancient Aztecs, who already 
cultivated corn and cocoa, and lived on a plentiful and 
varied diet, although principally a vegetable one, had a 
well-ordered state, with courts of justice very similar 



HEALTH AND WORLD-PROGRESS 227 

to our own. We can also show, by means of instructive 
examples of which we shall give several later on, how 
both man and beast are made what they are by their 
foods." "* According to the same authority health is 
likewise a matter of combating bacteria. " We eat in 
order to build up our tissues, we eat in order to put our- 
selves into condition to withstand the endless assaults 
of lower organisms which attack us by day and by night, 
and we also eat in order that our organs, and in par- 
ticular our brain, will be enabled rightly to perform 
their functions." "* 

If this reasoning be correct, two problems will be ex- 
plained. First, why disease-ridden people cannot de- 
velop a strong body and mind ; second, why inadequately 
nourished people cannot develop a completely healthy 
body and mind. The first problem has been dealt with in 
the preceding pages, and need no longer be discussed ; the 
second needs brief mention here for the purpose of ex- 
plaining the movements of civilization. 

The peoples coming from northern latitudes or higher 
altitudes in the south were unusually free from bacteria, 
which enabled them to develop strong bodies and minds. 
They lived, however, chiefly on a meat diet, and developed 
restlessness and ambition. Their strong bodies and minds 
represented merely raw material which required work- 
ing over through a supplementary vegetable diet and 
contact with different social organizations in southern 
latitudes. This opportunity was furnished them by their 
migrations south or from the mountains to the valleys. 
This explains why these people were the last to be 
reached by civilization in their native home around the 
Baltic ; for Germany, Great Britain, and the Scandinavian 
countries were the last to become civilized. It also ex- 
plains why these people with their more excitable nervous 



i 



f 



228 HflALTH AND SOCIAL PROGRESS 

organization fell victims more readily to the various en- 
demic diseases in southern latitudes, especially as they 
were without racial training for them. In proportion 
as these migrations became more difficult or impossible, 
and transportation of southern products to the north be- 
came more frequent and regular, civilization could move 
northward. So we find the Egyptians and Babylonians 
in almost direct contact with the tropics, but living in 
the sub-tropics ; later the Greeks and Romans in indirect 
contact with warmer climates; then the Venetians and 
Genoans, supplying the rest of northern Italy with south- 
em products; still later the Spaniards, Portuguese, and 
French, who came into more direct contact owing to the 
discovery of new sea-routes ; finally, the Dutch, English, 
Germans, and Scandinavians either in direct or indirect 
contact with the tropics and sub-tropics. This contact, 
which has now become well established, is another factor 
in the permanency of civilization, and assures its con- 
tinuity as well as its world-wide character, since these 
nations will always depend on the tropics for the supple- 
mentary articles to their prevailing nitrogenous diet. 

This means, that the southern countries must in turn 
be made more habitable in order to be able to meet the 
larger demands for their products by men in temperate 
zones. We have seen what has been done by way of 
sanitation in a very short time at certain points which 
were looked upon for centuries as pest-holes. It will now 
be necessary to point out that the tropics need the prod- 
ucts of the temperate zone. The people in the warmer 
climates live principally on a vegetable diet which is as 
one-sided as that of the people in the extreme north. 
Their diet needs, consequently, supplementing with more 
nitrogenous foods. Medical science is agreed now that 
a poorly balanced diet produces scurvy on the one hand, 



HEALTH AND WORLD-PROGRESS 229 

and beriberi, rickets, and pellagra on the other. If either 
too much meat or too many vegetables can produce 
serious diseases, it stands to reason that a poorly balanced 
diet cannot produce a fine brain. 

The opinion that but little animal food is necessary in 
warm climates has been abandoned. Major Woodruff, in 
speaking about what white men should do in southern 
latitudes, says: 

" This brings up the question of food, and it is well to 
say that physicians are now almost unanimous in declar- 
ing that the old doctrine that we should eat very lightly 
of animal food in the tropics is a very pernicious one. 
The natives are now known to be suflFering from nitrogen 
starvation and we should not imitate them in this respect 
any more than we should imitate their filthy habits." ^^' 

We know that General Gorgas turned the negroes into 
good workers by a fair allowance of meat. The Japanese, 
too, have become more efficient by resorting to a mixed 
diet, especially in the navy and army. If we want the 
people in the tropics to produce the vegetable food we 
need, we must supply them with the animal food they 
need, because only in that way will they be able to work 
better and produce more. 

The common interest of men in temperate and warm 
climates is thus established, and it would be well to 
reckon with the fact by taking a larger view of our mutual 
dependence. Hitherto our attitude toward men in the 
tropics has been one of condescension ; we have either ex- 
ploited them on the more or less explicit understanding 
that they were inferiors ; or we have given them religion, 
education, or free political institutions with the idea that 
this was all they needed to become like ourselves. But we 
have never acknowledged that our relation to them is 
one pf mutual dependence, and so we have failed to give 






I 



230 HEALTH AND SOCIAL PROGRESS 

them what they most needed — the means to keep healthy 
and to become intelligent workers. A beginning has been 
made in regard to proper sanitation of the tropics, as has 
been shown above, and we are just coming to recognize 
the necessity of making these people prosperous by a 
more intelligent management of their affairs. 

Whether this management is to be by the control of 
white men, or whether it is to be intrusted to the colored 
races, is a question which cannot be answered finally at 
present. In the past the relation of the whites to the 
colored races has usually been one of parasitism or open 
exploitation, and this has warped our whole mental atti- 
tude in regard to their actual and potential capacities. 
The assumed natural and permanent inferiority of the 
inhabitants of warmer climates was a ready argument 
with those who wanted to profit from their ignorance and 
inexperience. And so we find almost all observers testify 
to the laziness, lack of capacity, shiftlessness, and other 
shortcomings of the southern races. Practically all im- 
perialists are unanimous in this respect, but one quota- 
tion will sufficiently indicate the trend of opinion. Judge 
Lambert Tree, speaking of the fact that white men can- 
not live in the West Indies, says : 

" As the white man loses his grip the black man tightens 
his, and hence is perceived everywhere, substantially, 
negro control. 

" Thus, in that precious republic Hayti, the white man 
is not permitted to hold real estate, and a number of other 
privileges are denied him which are permitted to the 
black citizen. Judging from the examples of negro rule 
in Hayti and Santo Domingo, as well as from the social 
and political conditions in other of the West Indies where 
they are in partial control, it would seem that the 
negro is 3een at his be$t where he is under the influ- 



HEALTH AND WORLD-PROGRESS 231 

ence and control of a considerable body of the white 
men. 

" By himself, it is nearly, or quite, self-evident that 
he is not capable of administering government for the 
general welfare of the people over whom he rules. The 
negro is an imitator, and with the influence and example 
of the white men absent, racial instincts beyond his con- 
trol seem to draw him back as by the * call of the wild.' 
His idea of government in the republics in the West 
Indies he rules over, is to plunder the weak. * Might 
makes right ' is the rule of the barbarian, and this is the 
rule of those whence he sprang and toward whom he is 
again drifting. If the negro is left to himself much 
longer in Hayti and Santo Domingo, all government will 
ultimately disappear except that of the tribal relation. 
Nothing is more clear than that he is retrograding in that 
direction." *^' 

The picture drawn by Judge Tree is undoubtedly cor- 
rect, but the causes assigned are open to question. He 
is evidently convinced of the racial inferiority of the 
negro, and that serves as a sufficient cause and explana- 
tion of the present condition of Hayti and Santo 
Domingo. The same charge has been made against 
the peon of Porto Rico, against the whites of the various 
Central and South American republics, of Mexico, and 
of our own Southern States. Mexico in 1913 and 1914 
presents analogous conditions to those of the two black 
republics ; yet there are few negroes in Mexico, and com- 
paratively few in Honduras, Guatemala, Costa Rica, 
Venezuela, Colombia or Peru. Nevertheless, Major 
WoodruflF, who quotes Judge Tree concerning Hayti, 
says : " Venezuela is not a republic at all, but a turbulent 
mob without organization, because there are not brains 
to organize the units. Murder, pillage, and freebooteiy 



I 



i 

! 



Iiiii 




232 HEALTH AND SOCIAL PROGRESS 

dominate it from end to end. Neither life nor property 
are safe. Population and industry are declining. Inves- 
tors are excluded just when their investments are to turn 
out mutually beneficial. It has brought us to the verge 
of war more than once. It is, then, not fanciful to pic- 
ture the United States as the policeman of the Caribbean 
using a ' big stick * to threaten the nations into decency. 
It is a living necessity of more complete mutual relations 

in the future." "^ 

Judge Tree puts the blame on race. Major Woodruff 
on the actinic rays of the sun, neither of which factors 
we are able to control, and so no other policy is left but 
that of the " big stick." But that policy has been tried 
for several hundred years. The negroes in the Caribbean, 
and the brown and the red peoples all over those and other 
tropical regions have been exploited by chicanery, fraud, 
and force. At the same time we have sent our mission- 
aries and our teachers to declare to them the oneness of 
mankind and the equality of all men. And then we 
wonder that they cannot reconcile the application of the 
lash with the offer of professed brotherhood. Poorly 
nourished brains are the natural breeding-places for 
wild ideas. Who can blame these people— with blood 
impoverished through poor food, malaria, uncinariasis, 
and in a large number of cases from venereal diseases-- 
that the wildest kind of ideas originated or took root in 
their poorly nourished brains, when for several centuries 
the discrepancy between our preaching and our practice 
was forced upon their attention? What but brutal re- 
taliation can be expected from peoples who, generally 
speaking, have been subjected to all forms of abuse which 
greed and lust could invent? This is not to justify but to 
explain the behavior of the Haytians and other peoples of 
southern countries toward the white men whenever they 



HEALTH AND WORLD-PROGRESS 233 

were able to retaliate. The cruelties perpetrated upon the 
Congo negroes and the Amazonian Indians for the sake 
of raw rubber are still fresh in the memory of every 
newspaper reader. Who would blame these people if they 
should rise and avenge themselves upon their oppressors? 
Who can blame them if they loathe labor when it benefits 
others only and becomes a means of endless torture to 
themselves? We have tried to show previously what rad- 
ical changes often take place in men whose poorly nour- 
ished brains could hardly contain the simplest ideas or else 
gave rise to all kinds of wild schemes, after they had been 
freed from endemic diseases. Would it not be well to 
try a similar course with other peoples before we hastily 
pass judgment upon them as worthless and inferior? 
Wherever this has been attempted the results have been 
favorable. A quotation about a country which Major 
Woodruff so severely condemns will perhaps best serve 
the purpose. An American who closely observed the 
people in the Orinoco region of Venezuela has written 
to the Rockefeller Sanitary Commission this opinion : 

" Venezuela is a country of marvelous and limitless 
natural resources. If the hookworm can be abolished 
and these listless, lifeless, almost worthless people, who 
are in this condition because of disease, can be trans- 
formed as a young man was whom I saw restored there 
by an English physician, into vigorous, red-blooded, 
mentally alive people, their economic efficiency can be 
increased a thousandfold and the country can be started 
on a career of development which will make a factor 
in the progress of the world. 

"Poorly nourished brains are the natural breeding 
places for wild ideas. I believe that the eradication of 
the hookworm will do more than any other one thing to 
banish the chronic state of revolution from the countries 




!t. 



234 HEALTH AND SOCIAL PROGRESS 

of Latin America and allow these countries to attain 
the prosperity to which they are entitled by reason of 
their natural resources." ^^® 

This quotation indicates the line which mutual relations 
between peoples of the temperate zones and the tropics 
should take. We can give them health, some of our foods, 
and our manufactured articles; they can give us their 
foods, raw products, and such beverages as tea, coffee, 
and cocoa. This would be mutually advantageous, and 
the relation of parasitism, which we have maintained, 
would change to commensalism. Owing to the gradual 
disappearance of the economic theory that he is richest 
who sells most and buys least, we shall learn that the 
prosperity of the tropics will be to our advantage, for 
they will buy more, and our prosperity will enable us to 
buy more from them. We need each other; and the 
further we advance, the more interdependent we become, 
since the higher a ciznlisation, the more numerous and 
varied are the factors of existence — physically, mentally, 
and socially. 

This law has been applied to physical sustenance, but 
it can easily be shown that we owe a good deal of our 
understanding of our mental, moral, and social develop- 
ment to the study of the lower races still extant. The 
study of these peoples has been incomparably more fruit- 
ful in yielding valuable results for the history of civiliza- 
tion than that of the few remains of primitive man in 
various parts of the globe. This is especially true of the 
development of morality and social customs, to both of 
which the finds in Java, in the Neanderthal and Spy, or 
elsewhere, have contributed nothing. On higher levels of 
civilization we become mentally interdependent, as in the 
sciences and many of the arts. No nation is self-suffi- 
cient in these respects, and a discovery in France is just 



HEALTH AND WORLD-PROGRESS i 233 

as important to Americans as one made by our own 
countrymen. The internationalism of science is estab- 
lished, that of commerce has begun, and that of politics 
must follow. Only in proportion as we are in touch 
with all nations, can we expand and broaden. And this 
contact with others must be of a mutually beneficial 
nature. The old exploitation of nature-peoples must 
cease, and we must stop treating them as inferiors. 

The question how to control the tropics — if it is granted 
that we need them — is difficult to answer, and not a part 
of our discussion. One thing is certain, though. Our 
attitude toward tropical peoples must change if we are 
not to endanger our own existence. They must be put 
into a condition to produce the articles we need, and 
that is impossible if we continue to employ the policies 
pursued in the past. Furthermore, our attitude toward 
the whole problem of the inhabitability of the tropics 
must change. If climate or intensive light is responsible, 
we can do practically nothing, since these factors are 
unchangeable, or only very slowly and slightly 
changeable ; and we must always remain, to some extent 
at least, slave-drivers in the warm countries. With our 
constantly growing population and rising civilization our 
demands for tropical products must of necessity increase ; 
and if it be granted, that for a number of generations the 
hot countries will be uninhabitable for white men and 
that the natives of these countries are unable to escape the 
enervating influences of the climate and produce little — 
we cannot avoid the conclusion that the brown and the 
black races will soon be exterminated, through our greed 
for their products. If we only take without giving some- 
thing valuable, these people must die, as numerous races 
have already done. If, on the other hand, we give what 
we can spare, and take what they have in abundance. 



236 HEALTH AND SOCIAL PROGRESS 

there is no need of dreading the future, since there will 
be enough produced for all. The white man may then 
stay in his native clime and send representatives to all the 
tropics to guide the natives in their industries and ex- 
change their products for ours. 

What we can give, is health. We have just begun the 
study of the factors which make for health, and have 
already achieved much. In proportion as we study these 
factors more and attain better results, we shall be able to 
make invaluable contributions to the welfare and happi- 
ness of the tropical peoples. They will be able to look 
after themselves better, produce more, and buy more. 
If the results already attained justify any conclusion, 
there would seem but little doubt that we have it in our 
power to make the tropics healthy at least for the natives. 
Disease is a factor which we have learned to control in 
part; and we shall soon learn how to do it better. On 
the basis of the conquest of yellow fever, malaria, 
typhoid, uncinariasis, and the bubonic plague, it will be 
in our power to re-make the tropical and sub-tropical 
peoples, and bring their lands into the service of civiliza- 
tion as fast as their products are needed. This will be 
a long step taken for the advance and well-being of the 
whole human race. 

It is true that our desire to make the tropics healthy, 
will not be sufficient. But it is true that the results at- 
tained in the control of the endemic and epidemic diseases 
mentioned justify the conclusion that we can do it if we 
try, while it is at least doubtful whether the heat and the 
light of those regions are the cause of the low physical, 
mental, and moral condition of the inhabitants. Civiliza- 
tion is becoming more conscious of itself, and, conse- 
quently, more telic in its endeavors. What used to be 
considered unalterable factors *or immutable laws of 



HEALTH AND WORLD-PROGRESS 237 

nature, have been found to yield to intelligent treatment 
when we learned to understand them. Disease was not 
so long ago looked upon as an important item in our 
moral training, and therefore inevitable. We know now 
that it is the very opposite, and avoidable. In proportion 
as we plan intelligently and analyze factors of life scien- 
tifically, we find that we are making progress in all 
directions. This statement may be illustrated by the 
attempts to lengthen the average life of man. 

According to the records of the city of Geneva, 
Switzerland, the average span of life was 21.2 years in 
the 16th century; 25.7 in the 17th; 33.6 in the 18th, and 
39.7 from 1801 to 1883 ; while in Sweden at present it is 
50.9 years for males and 53.6 for females; and in 
India only 23 for males and 24 for females. One may 
grant that India is less healthy than Sweden; but the 
fact that the life span in Switzerland and in all other 
progressive countries has lengthened so considerably, is 
proof of what intelligent and progressive measures can 
do. India, with its superstitious people, showed no ad- 
vance from 1881 to 1901 — 3, period fruitful in advances 
along this line in all European cotmtries. 

Sweden is a conspicuous illustration of what can be 
done by a scientific view of health. It has achieved most 
because it has looked upon the problem of health as a 
whole. In America infant mortality and tuberculosis 
have attracted wide attention ; protection against germs 
has been given all possible publicity. Germany has paid 
much attention to sanitation and a proper water supply. 
Sweden has looked upon health as the result of various 
causes — ^heredity, sanitation, diet, temperance, exercise, 
personal hygiene, instruction; and has emphasized each 
one in proportion to its relative importance. The result 
it not only a greater average length of life, but a smaller 



238 HEALTH AND SOCIAL PROGRESS 

death rate than in any other country. While reduction 

in the death rate elsewhere, e.g., in the United States, is 
due chiefly to a very much smaller mortality rate among 
children with an undiminished, if not increased, death 
rate among persons just past middle life, the improve- 
ments in Sweden are general, and the chances for all 
age classes are better. Infancy, middle age, and old age 
show a lower mortality rate there today than in times 
past. The Swedes have realized that even the excellent 
opportunities of a healthy covmtry may be improved by 
the application of intelligence; that it is our duty and 
privilege to be well and happy, and to have an abiding 
sense of the beauty and nobility of a sound mind in a 
sound body. 

When other nations begin to have a simibr ideal of 
health and try to realize it by every known means and 
by others still to be discovered, saner views will be 
entertained concerning the sanctity of human life, not 
only in the temperate zones but in the tropics. We shall 
realize that there need not be such a tremendous waste 
of lives in those regions for the sake of a few products 
not obtainable elsewhere, and we shall try to give those 
peoples the one thing which will assist them in becoming 
not only better producers, but better men, parents, and 
citizens. This contribution of our knowledge will help 
them as well as ourselves, since in proportion as we give 
it to them, they will be able to return to us the products 
of nature, which the tropics alone can produce. A gen- 
eral improvement in character is bound to follow if our 
statements and facts quoted, have any meaning. And 
it is better characters that mankind needs at present if 
civilization is not to halt but to rise and spread. We 
need more endurance, more patience, more forbearance, 
greater willingness to apply the laws of health already 



HEALTH AND WORLD-PROGRESS 239 

known, and optimism to believe that it depends largely on 
ourselves whether we are to be well and happy through 
productive work, and the giving of our own surplus to 
those who give us of theirs. The problems of nutrition, 
eugenics, sanitation, and personal hygiene must receive 
more attention on the part of intelligent men and women ; 
and only social cooperation within the nations and of the 
nations with each other is necessary to obtain good 
health for all. Physicians are working most unselfishly, 
and are performing ahnost herculean tasks along this 

line. 

Are our statesmen awake? Shall we have to wait 
much longer for a national department of health? Con- 
servation of our natural resources is being agitated in our 
legislatures and congress. It is a necessity pressed upon 
us by their rapid depletion. But the conservation of 
human lives, the improvement of our health, and the in- 
crease of our vitality are certainly as important for the 
continuation of the nation. In the past the fate of na- 
tions and of armies depended on health; this has been 
the principal agency in the re-arrangements of the map 
of the world, and it has always been the most potent 
factor in civilization. The varied activities of the twen- 
tieth century are all of the greatest importance, but sani- 
tation contains the great promise for the future. 

" It may be that we are today spectators at the begin- 
ning of one of the most important periods of history, 
and are standing on the threshold of an epoch that may 
change the standards of mankind, and establish new 
limits for human achievement. 

" It is also possible that this period may mark the dawn 
of a new civilization, wherein the conservation of the 
health of the individual is a basic principle; a civiliza- 
tion that recognizes that the highest development of the 



240 HEALTH AND SOCIAL PROGRESS 

race depends upon the health of its members and that 
progress and science, the arts, commercial achievement, 
and other fields of activity, are limited by the physical 
capabilities of its people. What the results of this great 
movement will be, no man can fully predict. That its 
effect upon the nation will be profound, there seems to be 
no question ; but who will attempt to mark the confines 
of its effectiveness, or prescribe the boundaries of its 
influence?""* 



t. 



•■/ 



CHAPTER XIII 

HEALTH AND ORIGINALITY 

Whatever view one may take concerning the origin 
of genius, the influence of the men who possessed it 
cannot be denied. Whether those men are looked upon 
as insane, as by Nisbet ; as degenerates, as by Lombroso 
and his school ; or whether they are considered the quin- 
tessence of a nation, one fact stands out prominently — 
they have influenced history profoundly. Among savage 
tribes they were chiefs and warriors; among the semi- 
dvilized, founders of religion and of crude philosophy; 
among civilized peoples they are military commanders 
and statesmen, artists and philosophers, men of letters and 
of science. Their influence has entered every sphere of 
life, and they win the admiration of their fellowmen by 
striking out into new paths, in some cases owing little 
to education, in many cases arising from the most humble 
environments and fighting their way against numerous 
obstacles into positions of prominence among their con- 
temporaries and posterity. It will, therefore, be neces- 
sary to treat genius briefly from the point of view of 
heahh, to discover, if possible, whether the leaders of 
civilization have been healthy men, or whether they 
have been diseased. The question of civilization is 
rather closely connected with that of genius, if once 
the tatter's influence upon history has been ad- 
mitted. 

If civilization is the product of healthy peoples, the 
leaders must have been healthy men. This conclusion is 



HEALTH AND ORIGINALITY 



243 




242 HEALTH AND SOCIAL PROGRESS 

inevitable, if the facts on the preceding pages have any 
meaning. 

Genius means an extraordinary capacity for making 
syntheses. This definition will cover all kinds of geniuses 
as they have appeared in history and influenced the fate 
of nations. The material used by genius may, however, 
be of two kinds ; it may be developed chiefly from within, 
as a result of a lively imagination ; or it may be the result 
of observation and study of facts. This gives us what 
may be called subjective and objective genius. It would 
be impossible to draw a clear line of demarcation between 
the two types, just as it is extremely difficult to dis- 
tinguish the anthropological races sharply from each 
other. In a general way the distinction holds, however; 
and an attempt will be made to make it clear. 

The genius has, then, an extraordinary capacity for 
synthesizing in the meaning of Kant, i.e., the organiza- 
tion of the manifold, whether of external or internal sen- 
sation, under some unifying principle. In proportion as 
this capacity is general, the genius is of the highest type 
and covers several fields, like Leonardo da Vinci, who 
was painter, sculptor, architect, musician, mechanical en- 
gineer, and natural philosopher. In proportion as it is 
specific, genius is confined to one particular line of work 
with, perhaps, corresponding lacuncc of knowledge in 
other lines; like Turner, who, according to Nisbet, 
" stands alone as an example of a surpassing faculty 
for color, combined with the lowest intellectual 
powers." "® Between these two extremes there are 
numerous intermediary stages which it is not necessary to 
follow. It is more important to show what genius is, 
biologically and sociologically. 

Genius is a useful variation and constitutes the few 
outlying members of an orderly series, the members i 



the group diminishing in number according to determined 
laws as the degree of eminence or divergence from the 
average increases. If this statement is true, we should 
expect that the greater the genius, the better health its 
possessor must have. What then, do we find in this 
respect? It may be convenient to select a few men whose 
genius is universally recognized. Omitting the ancients 
owing to the scarcity of reliable data concerning them, 
we may begin with modern men. 

A few remarks must be made, however, before wc 
proceed to these men. If we remember that health is not 
necessarily identical with robust strength or athletic 
and muscular development but rather with sound morpho- 
logical structure and physiological function, we shall 
see that a number of men come under the heading of 
** healthy" who do not pass ordinarily as strong men. 
Vitality is more important than muscular development 
or brute strength; ability to resist small but constant 
ailments is a better measure of health and vitality than 
ability to lift weights or run a Marathon race ; and regu- 
lar mental exertion is a better index to brain power and 
general physical endurance than mere physical labor for 
eight or ten hours a day. That the strain from brain 
work is a greater tax on the constitution may be inferred 
from the fact that more brain workers break down than 
day laborers. Formerly such men were poets, artists, 
philosophers, and scientists; business men and manual 
workers were comparatively free from collapse. When 
business began to partake more of the nature of mental 
exertion, the number of breakdowns among business men 
increased rapidly ; and the same thing is happening with 
manual laborers when their work requires not so much 
strength as close attention to a machine or the manipula- 
tion of a few deft but continuous and exact movements. 



244 HEALTH AND SOCIAL PROGRESS 

It is the constant effort along a particular line and the 
continuous exertion of a particular organ, which is more 
detrimental than general physical labor, although heavy. 
There is more rest in the latter case for all organs owing 
to the change in occupation. For the specialist, which 
the mental worker has always been, this rest is impos- 
sible; hence more frequent breakdowns among this class 
of workers were unavoidable, although deplorable, at a 
time when the human machinery was less understood 
than at present, and when the mind was considered to 
be independent of the body. The general neglect of the 
commonest rules of health among mental workers is 
one of the saddest chapters in the history of intellectual 
development, and the recognition of the interdependence 
of sound mentality and sound corporeity is one of the 
greatest advances made. In proportion as this principle 
came to be adopted, the lamentable failures in health 
among mental workers decreased in frequency, since these 
men are now among the healthiest specimens of the race, 
and knowledge of a socially useful kind has advanced 
proportionately. In looking over the history of geniuses 
and other mental workers, we should remember this fact 
concerning the general neglect of the body. Even the 
most robust constitution must become weakened, if not 
ruined, by the abuse of the body; and the result is in- 
evitable — vagaries and the wildest kinds of superstitions 
outside of the regular vocation of the scholar ; e.g., New- 
ton's ideas on religion in the Apocalypse. 

Another thing which should be borne in mind before 
judging geniuses as insane or degenerate, is the love of 
these men for their work. Whenever anyone becomes 
too much interested in his vocation, overexertion in its 
pursuit is apt to occur. Perhaps no work is as fascinat- 
ing as mental work, at least to those who are inclined 



HEALTH AND ORIGINALITY 



245 



that way. The result is absorption to the extent of not 
only neglecting the body by denying it proper rest and 
food, but abusing it by too much strain in the line of one's 
specialty. The constant use of one particular organ 
may strengthen it, but at the expense of other organs; 
these will in consequence become weaker and unable 
to do their work properly, and their gradual deteriora- 
tion must eventually produce a weakening of the constitu- 
tion as a whole, including the organ strengthened at the 
expense of the others. A slight irregularity in the con- 
struction of the most used organ will often cause a 
tremendous strain not only on the organ itself, but 
through it on the whole body, because the organ is handi- 
capped and is called upon to do perfect work with an 
imperfect instrument. This is particularly the case with 
the eyes, which during waking hours have practically no 
rest, especially in the case of near-workers who have to 
concentrate vision on small objects, and often require 
great precision of vision for the proper performance of 
their duties. A slight astigmatism in such a case may 
produce a heavy strain on the whole nervous system, 
as Dr. George M. Gould has pointed out.^»^ If to this 
near-work with the eyes there is added the strain of 
continual deep thinking, the nervous system is kept in 
a constant tension and must eventually give way, or 
must at least suffer. Dr. Gould explains the poor health 
of many men of genius and the physical ruin of others 
through this strain of poorly constructed eyes, which in 
former times could not be relieved by proper glasses ow- 
ing to ignorance of how to correct numerous and often 
purely individual refractions. Among the men he dis- 
cusses are De Quincy, Carlyle, Darwin, Huxley, Brown- 
ing, George Eliot, Wagner, Parkman, Herbert Spencer, 
and Nietzsche. While physicians generally declare Dr, 



246 HEALTH AND SOCIAL PROGRESS 

Gould to be an extremist, he had the indorsement among 
others of the nerve speciaHst, Dr. Weir Mitchell. That 
constant although slight irritations may cause serious 
effects was, however, brought out at the meeting of the 
International Surgical Association in New York by Dr. 
A. J. Ochsner of Chicago and by Dr. William J. Mayo, 
of Rochester, Minn. The former in particular claimed 
that constant irritations may and do cause cancer of the 
stomach.* 

We have here a parallel case to that discussed in pre- 
vious chapters concerning the cumulative effects of en- 
demic diseases which do not kill, but vitiate vitality 
through constant interference with vital functions by 
almost uninterrupted nagging and irritation. As there, 
so here we may explain many effects on civilization by 
means of small defects. There we had the endemic 
diseases which prevented men from reaching a full and 
vigorous manhood; here we have in many cases specific 
small ailments which sometimes warp an otherwise strong 
mentality, and sometimes prevent a full development of 
social usefulness. 

These facts are referred to in order to show that some 
men of genius who were afflicted with maladies may have 
had good heredity, that the structure of their bodies was 
good, and that some particular small ailment which went 
uncorrected either through ignorance or negligence was 
responsible for many breakdowns and infractions of 
logic and social conventions. 

Nisbet and Lombroso forget to take social conditions 
into account when they charge men of genius with oddi- 
ties and disregard of social rules. Even a great man is still 
a human being and subject to the foibles and follies of his 
times. Greatness must exert itself along the current social 

*Mf(iicQl Record, New York, April 25, 1914, p. 77^ 



HEALTH AND ORIGINALITY 



247 



channels. In the Middle Ages most men of talent went 
into the service of the church either directly as monks and 
priests or indirectly as artists and architects. During 
the Napoleonic era most of such men went into the army 
because the rewards were highest in that service. In 
our own times the most energetic men go into business. 
As in great things so in small. If a particular society ex- 
pects the genius to be odd and unkempt, he will accommo- 
date his fellowmen and become a mendicant monk; if it 
expects him to exhibit his power by splendor and ostenta- 
tion, he will build magnificent palaces and adorn himself 
with gorgeous robes ; if it wants him to be a " Bohemian," 
he will be wild and reckless in his speech, dress, and 
manners; if it wants him to live a proper life as other 
mortals do, he will submit to social conventions. A 
genius becomes more amenable to social proprieties in 
proportion as other men demand that he should act like 
others instead of one exempt from human laws. Many 
things were not only forgiven the genius in the past, but 
were directly expected of him for which a more proper 
and conventional age would condemn him. Let us now 
consider ten men of genius from the point of view of 
health. 

Among naturalists we have Darwin and Spencer. The 
former is reckoned even by Lombroso among sane men 
of genius. Darwin lived to be 73 years of age. He had 
inherited a strong constitution, as is proved by the fact 
that he "wasted" his time at Cambridge by shooting, 
hunting, riding, and sporting, and was in excellent health 
and high spirits. Whether it was his five years* journey 
on the Beagle, or the constant trouble with his eyes which 
interfered with his health, it is impossible to determine 
now. He suffered, however, from nervous weakness the 
rest of his life, but managed by careful limitation of his 



I''il 



im 



m 



248 HEALTH AND SCKIAL PROGRESS 

studies and by the removal of all unnecessary distrac- 
tions to accomplish work not only comparatively large in 
quantity, but very high in quality. A man who could 
write of himself in his old age, after having been recog- 
nized as the foremost scientific man of his times, the 
words following must have had an almost perfect poise 
and balance, resulting from good physical structure. 
" My success as a man of science, whatever this may 
have amounted to, has been determined, as far as I can 
judge, by complex and diversified mental qualities and 
conditions. Of these the most important have been — ^the 
love of science — unbounded patience in long reflecting 
over any subject — industry in observing and collecting 
facts, — and a fair share of invention as well as conunon 
sense. With such moderate abilities as I possess, it is 
truly surprising that I should have influenced to a con- 
siderable extent the belief of scientific men on some im- 
portant points." *•* 

Herbert Spencer had a remarkable vitality, as is shown 
by the fact that at the age of thirteen he became home- 
sick at school and started one morning at six for home, 
walking 48 m3es the first day, 47 the second, and 20 the 
third, with very little food during the three days. He 
was a good runner and skater as a boy. As a draughts- 
man at twenty-one he worked from eight in the morning 
to twelve at night and one day a week he worked till three 
in the morning, keeping at this schedule for several years. 
This strain resulted in a nervous breakdown at the age of 
thirty-five, but he continued in fair health until sixty-two, 
when he had to shorten his customary long walks. A 
man who lived to the age of eighty-three, and wrote such 
a large quantity and of good quality, whose range of 
knowledge was so encyclopaedic — must have had an ex- 
cellent constitution, such as could be ruined only by 



HEALTH AND ORIGINALITY 



249 



utter disregard of all rules of health. But it responded 
quickly as soon as Spencer began to take better care of 
himself; otherwise he could not have accomplished the 
work he did. Mention should be made here of A. R. 
Wallace, perhaps equally prominent as a naturalist, who 
passed the age of ninety years, but kept vigorous in body 
and mind till very near his death. 

Among the philosophers, Kant and Hegel are the most 
prominent in modem times. Of the former we read: 
** He enjoyed good health, was absolutely regular in his 
daily habits, free from the cares of family-life, and, for 
three-quarters of a century, devoted to science and intel- 
lectual pleasures." **' He lectured at the university until 
seven years before his death, lived to be eighty years of 
age, was cheerful in temperament and social in disposi- 
tion. Hegel lived only sixty-one years. Lombroso does 
not mention him, and Nisbet only states that his sister 
was insane, but does not give the cause. H^el was never 
a strong man, but neither was he sick. His vitality was 
what is technically called "medium," and with good 
care of his health he was able to keep very busy, accom- 
plishing a remarkable amount of work of the highest 
order. I have found only one reference, in Ktmo 
Fischer's volimies, to Hegel's health when he was pro- 
fessor in Berlin : " Die f riih gealterte Figur war gebeugt, 
doch von urspriinglicher Ausdauer und Kraft." ^** When 
about sixty-one years old he began his winter lectures 
with a fire and energy which surprised his hearers, but 
died in November of that year (1831) of cholera, which 
proved almost invariably fatal in those days. 

Of modern poets Shakespeare and Goethe are among 
the foremost. Lombroso is silent concerning the bard 
of Avon, but Nisbet says : " Shakespeare's perceptions 
must have been extraordinarily keen and persistent. His 



i 



250 HEALTH AND SOCIAL PROGRESS 

mind must have photographed everything he saw. Na- 
tural scenery, natural objects, human character, society 
and its usages — all must have been vividly impressed upon 
his brain, and there associated with extensive and hardly 
less vivid memories. Had we known the man we should 
probably have discovered that he had limitations. All 
we can gather from his writings is that his surroundings 
must have impressed him with a force out of all propor- 
tion to the attention he could have given them, and that 
his impressions being retained must have furnished him 
with an enormous amount of intellectual material and a 
basis of comparison infinitely greater than that possessed 
by ordinary men. He seems to have been untraveled, 
and to have had but a moderate knowledge of books ; yet 
by dint of acquisitions — ^mainly visual in their origin, but 
extensively cohering together and thus creating a great 
identifying or constructive faculty — ^he was able to people 
foreign scenes and the ancient world with appropriate 
characters, and to supply them with incidents to match. 
Such immense creative power as Shakespeare's can only 
be understood in connection with a morbid impression- 
ability." ^" 

In the sixth chapter of his book, Nisbet bases his con- 
clusion as to the insanity of " the greatest poet that the 
world has seen " on the alleged great mortality of Shake- 
speare's family, on his supposed paralysis, and the incom- 
petence of his brothers. It may be well to remember here 
what was said above about the influence of social con- 
ditions upon genius. Those were the days of " merrie 
England," and there is no reason to expect that this 
dramatist did not enter into the spirit of his times with 
all the zest of a man who wants to enjoy himself and 
find what is known as " copy " in modem parlance. Be- 
ing engaged, moreover, in so many capacities, — actor* 



HEALTH AND ORIGINALITY 



251 



playwright, poet, stage manager and boon companion, — 
it would be a miracle if he had lived over fifty-two years 
under the generally unsatisfactory conditions of sanita- 
tion of those times. That he must have worked hard 
and managed well is shown by the fact that at the age of 
thirty-seven he bought a house and garden in New Place, 
London, and at forty-eight he was able to buy a free- 
hold house at Black friars for 145 pounds, and to retire 
to Stratford as a squire, which implied that he had at 
least a fair amount of property. Remuneration for any 
of the activities in which Shakespeare engaged was rather 
meager in those days, and the accumulation of a fair 
fortune in London by a runaway country boy indicates 
a good amount of common sense in addition to constant 
work. 

In regard to the alleged great mortality of the family, 
the records tell a different story. The poet was one of a 
family of eight, two of whom died in infancy, and the 
others reached the following ages: William, 52; Gilbert, 
46; Joan, 17 \ Annie, 8; Richard, 39; Edmund, 27. As 
the ages of the two infants are not given, we have 249 
years for the combined age of the other six; divided 
among the eight children, we get a little over 31 as the 
average age for the eight. This compares favorably 
with the average age in Geneva, Switzerland, which had 
an average age of 21.2 years in the 16th century, and 
25.7 in the 17th century. If we omit the two infants, 
we have an average of 41.5 years for the six children 
who survived — which compares well with Prussia's 
average of 41.0 for males and 44.5 for females during the 
period of 1891 to 1900. That two out of eight children 
died in infancy is not an argument for poor vitality of 
the parents, since the perils of infancy were infinitely 
greater at that time than they are at present in civilized 



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252 HEALTH AND SOCIAL PROGRESS 

countries. If the general infant mortality of England at 
that time had been that of the Shakespeare family it 
would have been 250 per thousand; this compares well 
with Austria's 227 dunng the decade of 1893 to 1902, 
and very favorably with Russia's 272 and Chile's 333 
during the same years. William's only son, Hamnet, 
died at the age of twelve, but his two surviving daughters 
reached the age of 66 and 17, respectively. Through his 
sister Joan, the Shakespeare family is known to have ex- 
tended over nine generations, the last known survivor, 
George Hart of Birmingham, having emigrated to Aus- 
tralia in 1864. Considering all circumstances, the vitality 
of the Shakespeare family is above the average of their 
time ; and remembering the condition of sanitation and of 
medical knowledge, and the social customs of those days, 
it is evident that the mortality of the family was cer- 
tainly not greater than that of the well-situated classes of 
the time. William must certainly have had a good consti- 
tution to do all the work credited to him, and to gain a 
competency at a poorly paying occupation; all this re- 
quired balance and good management. 

About Goethe we have more definite data. " He was 
a man of genius distinguished by the comprehensive char- 
acter of his ability. He was a poet and dramatist of the 
highest rank, his mind was stored with the most varied 
knowledge, and he contributed to the advancement of 
natural science. As minister of state and as director of 
a theater, he was occupied with practical affairs. 

" He reached the age of eighty-three years, and he 
passed through the phases of life in relatively normal 
circumstances; in his many writings there are most 
valuable facts which throw a keen light on his life and 
nature." ^^ 

He was, with the exception of comparatively short 



HEALTH AND ORIGINALITY 



253 



periods in his life, a healthy man, and maintained his 
physical and mental vigor to the very last, finishing 
" Faust " less than a year before his death. His strength 
and vitality were prodigious, and the balance of functions 
remarkable. His contemporaries agree that even in his 
old age he was still beautiful; and in his seventy-fifth 
year he walked for several hours at a time, forcing the 
pace and exhibiting an amount of strength which filled 
Eckermann, his companion, with delight 

Leonardo da Vinci was a person of splendid physique, 
outstripping younger men in feats of strength, and zealous 
in his multitudinous activities ; he lived to be nearly sixty- 
seven years of age ; and even Lombroso is unable to count 
any aberrations against him. 

Michelangelo was ascetic in his habits, worked with 
furious intensity up to his seventieth year, and then had 
enough energy left to plan and carry forward great archi- 
tectural works like St. Peter's in Rome. As poet, painter, 
sculptor, and architect he not only excelled most of his 
contemporaries, but is one of the few masters whose 
genius is of the very highest, retaining full possession of 
his faculties until his death in the ninetieth year of his 

life. 

Lombroso "^ has two objections to the soundness of 
his mind. One is his " complete indifference " to women ; 
the other, his religiosity in old age. In regard to the 
first supposed shortcoming, Lombroso admits the exis- 
tence of at least two letters indicating that the artist was 
capable of ardent love for women ; this in addition to the 
sonnets which mention women. The interesting thing in 
this connection is the absence of any mention of Kant's 
supposedly defective genius on this score. In regard to 
Michelangelo's religiosity, the only statement which needs 
to be made is Lombroso's omission to consider the spirit 



254 HEALTH AND SOCIAL PROGRESS 

of the time and social customs. When everybody — ^not 
excluding kings and emperors — ^tried to die in the odor of 
sanctity by donning a monk's cowl, it is easily understood 
why the artist should follow the general custom and try 
to make amends for his real or imaginary sins. Even 
hardened scientists like Lombroso feel this impulse to set 
themselves right with God in their old age, and that in 
a much less religious era like the twentieth century. The 
only difference is in the method. Michelangelo followed 
tiie approved method of his age by giving money to the 
church for masses and alms to the poor ; Lombroso died 
the defender and believer in a spiritism which he knew 
to be tinctured with fraud, and the champion of a 
*' medium " who had been exposed several times. That 
was not even the approved method of our age. 

The Bach family thrived for three centuries, com- 
mencing in 1550 and producing 29 musicians of emi- 
nence. Sebastian Bach, the greatest of the family, be- 
came blind shortly before his death at sixty-five, after 
such severe use of his eyes as perhaps few have ever 
endured. He was a man of tireless industry and great 
vitality, and the general respect in which he was held as 
an excellent father, friend and good citizen, proves that 
his contemporaries found him perfectly normal. 

Of Beethoven — the least promising from a physical 
point of view in this series of ten geniuses — we have a 
special study by Dr. James Frederick Rogers."® Bom 
of a consumptive mother and a sottish father, much 
abused in his childhood by having to practice for whole 
nights, he was nevertheless a physically strong man, and 
had a powerful constitution. Dr. Rogers says : " The 
physical Beethoven was a most impressive figure. He 
was not tall — was in fact, short — not over five feet five 
inches, but with broad shoulders, and very firmly built. 



HEALTH AND ORIGINALITY 



255 



Siegfried said that 'in that limited space was concen- 
trated the pluck of twenty battalions.'— On the whole 
his was not a handsome figure, 'but the ugly pock- 
marked man with the piercing eye was possessed of a 
power and beauty more attractive than mere physical 
charm.' One person described him as ' power personi- 
fied,' and another thought of him as Jupiter." Toward 
the end of his article Dr. Rogers says : " Beethoven re- 
mained physically robust to the last, notwithstanding his 
continual fight with disease. ... The examination of 
the wreck of that most powerful bodily machine showed 
the auditory nerves shriveled and degenerated, the liver, 
the source of his digestive disturbances, shrunken to half 
its normal size, and there were other signs of chronic 
disease. . . . The convolutions of the brain were more 
numerous and twice as deep as usual." He died at fifty- 
seven. 

In another article Dr. Rogers discusses the relation of 
the intellectual and the physical life. After examining 
about ninety men of genius and talent in various walks 
of life, he says : " Of those mentioned, some seventeen 
may be said to have been more or less delicate from child- 
hood, though most of these were by no means sickly 
much of the time. Some eight or ten more, like Darwin 
and Spencer, broke down after a healthy, vigorous youth 
and early manhood. At least fifty were robust and many 
of these remarkable for physical powers. The remainder 
were probably above the average in physical endurance, 
even if their physique and health was not so impres- 
sive." *•• 

The temptation is very strong to take up at least briefly 
the many men of our own generation who have attained to 
prominence in various fields of life, and to show that with 
increasing knowledge concerning the importance of health 



256 HEALTH AND SOCIAL PROGRESS 

for maintaining a sound mentality, the health of geniuses 
and talented men has generally been at least good, and 
in most cases excellent. The prominent men at German, 
French, English, and American universities are usually 
healthy, if not robust. We must, however, proceed to the 
second part of this chapter to discuss briefly what is 
meant by originality. 

Genius was regarded as a useful variation. Origi- 
nality then must mean useful innovation. A man cannot 
be regarded as a genius merely because he originates new 
ideas. Extraordinary power of synthesis may be of two 
kinds, socially useful or useless. The true genius is 
generally in close touch with his times; is keenly in- 
terested in the highest endeavors of his contemporaries, 
and tries to direct them not only into new, but into 
socially useful channels by virtue of his wider outlook 
and deeper insight. The genius is, consequently, the 
average man raised to the highest power; and this en- 
ables him to be more useful in directing the currents of 
his time than are the majority of men. " To know that 
the greatest men of earth are men who think as I do, but 
deeper, and see the real as I do, but clearer, who walk to 
the goal that I do, but better, — ^that may be an incitement 
to my humility, but it is also an inspiration to my life." *** 
Unless the genius contributes in some substantial manner 
to the welfare of his fellowmen, he may have a temporary 
vogue but no enduring fame. Mere originality in the 
sense of producing something new that has no relation to 
the well-being of man, may be indicative of great power 
of imagination, but it can startle only savages and bar- 
barians. There is more originality of this kind to be 
found in the Sacred Books of the East or in the 
Kwakiutle Tales of one tribe of the Columbian Indians, 
than can be discovered in our most resourceful poets. 






HEALTH AND ORIGINALITY 



257 



This originality had, however, very little, if any, con- 
nection with life, and left the people at the social level 
where the men highly gifted with imagination found it. 
Men of this kind may make many people rich with 
conjectural benefits, but the hollowness of their promises 
will soon be discovered. The medicine man and the 
shaman of various religions among barbarians, were com- 
pelled sooner or later to yield the first place to the war- 
rior who actually liberated his people from the enemy 
or protected them against him. With these tangible bene- 
fits the medicine man could not compete ; and in order to 
maintain his influence, he often resorted to fraud by go- 
ing into a trance, claiming inspiration from his deity, or in 
some other way. The magician of the Middle Ages was 
in a similar position; he often claimed power which he 
could not prove to be real, and so was not altogether un- 
justly incarcerated or put to death. 

What impresses people in the long run is the demon- 
strable and the true. This has been the only salvation of 
science in its long contention against ecclesiasticism — it 
could prove its statements by conferring substantial bene- 
fits upon society. Of the other type of men — rich in 
power of unbridled imagination — ^the vast majority have 
been at least slightly insane or degenerate. And it is 
mostly this class which Lombroso discusses ; but he shotdd 
not have honored these men with the name of genius. 

True genius is sane, because it is generally healthy. 
There are three tests of sanity for the genius — objectivity, 
attainability, utility. 

The genius produces something of which society may 
avail itself. Whether as poet, artist, philosopher, states- 
man, or scientist, he gives something to his fellowmen 
which they recognize as theirs, and adopt. A poem may 
be clothed in the most beautiful language, but will not be 



i\ 



■i 



258 HEALTH AND SOCIAL PROGRESS 

read if it does not somehow or other find an echo in the 
minds of the many. The experience expressed must be 
capable of being experienced by the average man when 
he reads it ; he must be able to say to himself, " this man 
expressed what I felt but could not state in words." A 
poem setting forth an unique experience which has no 
racial or national background is generally only an adorn- 
ment on the shelves of libraries or is consigned to the 
waste-basket, because it is not in touch with the current 
of life — the poet has failed to make his experience ob- 
jective, i.e., experiential by other men. The artist who 
appeals to the nation or to the race, has something in his 
picture or his statue, which stirs their imagination as 
something they have in common with him; and he will 
succeed in proportion as he is firmly rooted in the spirit 
of his age. Hence the greatest art has always been na- 
tional in character — Greek, Roman, and Medieval. The 
great artists of every age express the tendencies of the 
times in a higher key than other men can do; but the 
contact with others is always there, and close. The phi- 
losopher likewise expresses the best thoughts of his con- 
temporaries in the most logical and systematic manner. 
They understand him, because he is flesh of their flesh 
raised to a higher power. Hence the changing periods 
in art, poetry, and philosophy. Only the men of highest 
genius have succeeded in impressing themselves not only 
upon their contemporaries but upon posterity, because 
they treated subjects which concern all men in a masterly 
manner. The genius rose in this case from individual 
experience, thence through national to general human ex- 
perience. 

The scientist is, however, the most objective of all 
great men. He creates something which other men can- 
not only feel after him, but do after him. The artists 



HEALTH AND ORIGINALITY 



259 



of Athens and of Florence are still in many cases un- 
excelled, because their originality was only in part ob- 
jective. They succeeded in making others feel what they 
alone could express; but they could not teach their 
method; that was largely subjective. Others might see, 
admire, receive instruction, but could not produce more 
than replicas of the masterpieces. For art is subjective 
and a man must create his own method, and that is not 
communicable. If this statement were not true, we 
would excel the Greeks in art at least as much as we do 
in science. But we are still their unsuccessful imitators, 
notwithstanding the vast progress in the purely mechani- 
cal means which science has furnished the artist. The 
problem of art is, consequently, still unsolved and rests 
on that of individuality. 

Philosophy is more objective than art, because its 
reasoning can be followed, repeated, and improved by 
others. But it deals largely with ultimate problems, and 
hence rarely succeeds in solving any of them. The ques- 
tions which confronted Plato, the Stoics, Kant, and Hegel 
are still awaiting a final answer. The same problems are 
discussed today as of yore; we simply have more phi- 
losophies than before. 

It may be said that neither has science reached any 
definite agreement in regard to many points, as proved 
by the constant change in its hypotheses. That is true. 
There is, however, this diflFerence. When a scientist in 
Berlin reaches a conclusion, it can definitely be proved 
to be true or false, because the method by which the 
results were obtained is objective and the experiment can 
be repeated in London, Paris, New York, Chicago, Tokio, 
or Melbourne, and must yield the same results if the 
method is correct. If verification is impossible, the con- 
clusion or the method stands condemned; if the same 



260 HEALTH AND SOCIAL PROGRESS 

results are obtained, it is generally accepted and forms 
a permanent addition to knowledge, serving as a new 
basis from which other departures may be taken for 
further experiments. Again, differences among scien- 
tists occur chiefly in the realm of philosophy^ i.e., in the 
interpretation and ultimate meaning of facts. No one 
doubts, for instance, the phenomenal benefits derived 
from electricity. What electricity is, concerns not science 
so much as it does philosophy, because that problem is 
connected with the ultimate constitution of matter. The 
use of scientific imagination may eventually give an 
answer to that question, but meanwhile science proceeds 
from one conquest of nature to another by means of 
experiments, and puts an ever larger number of men 
into a position to do and repeat what scientists do. 
Science has made it possible to distribute the works of art 
and poetry more widely than ever, without producing any 
great men in these activities, although it has helped to 
increase the number of men attaining high rank in various 
scientific fields very considerably. Full objectivity re- 
quires sanity; i.e., balance of mind, ability to compare 
and to judge accurately, and self-control, so as not to be 
led away by whims and impulses. All this is possible 
only on the basis of good health. 

A remark may be in place here. The reason why the 
geniuses of the more subjective type were held in such 
high honor during the past seems to be the inability of 
the many to repeat what the great man did. When the 
shaman throws himself into a trance, few are able to re- 
peat the feat. This principle applies in a decreasing ratio 
to the poet, artist, and philosopher. On the other hand 
the scientist is more honored today, because we have 
emerged from the more emotional and subjective attitude 
to the intellectual and objective; i.e., we have gained a 



HEALTH AND ORIGINALITY 



261 



truer idea of the genius as a higher power of ourselves. 
He is no longer an enigma to us because we know that, 
being firmly rooted in social experiences, he drinks from 
the same fountain of knowledge as we do, but more 
deeply. 

Attainability is the second mark of sanity in genius. 
" The Kingdom of heaven (still) suffereth violence, and 
the violent take it by force.'* The kingdom of man is in 
the same position at the hands of the youthful genius who 
is full of violence and wants to bring about the millen- 
nium not only in impossible ways but in a wild rush. 
Very nearly every youthful genius has started out to 
declare war against society and to devise plans which 
were plainly unattainable. From Schiller and Shelley, 
down to Stimer and Nietzsche there is one continual 
variant of the same subject — society must be reformed 
rapidly and completely. The ways and means proposed 
betray an utter lack of insight into the slow and gradual 
development of intelligence and power of coordina- 
tion among men. The relation between means and 
ends is incomprehensible to this type of immature in- 
tellect. 

" The Solarian citizens have made wonderful progress 
in the arts and sciences. They have ships that plow 
the seas without sails and without oars; and cars that 
arc propelled by the force of the wind; they have dis- 
covered how to fly, and they are inventing instruments 
which will reveal new stars. They know that the world 
is a great animal in whose body we live, and that the 
sea is produced by the sweat of the earth, and that all 
the stars move. They practice perpetual adoration, offer 
up bloodless sacrifices, and reverence but do not worship 
the sun and the stars." *" One may argue that a number 
of things prophesied by Campanella in this passage have 



i 



i' 



262 HEALTH AND SOCIAL PROGRESS 

come true and he deserves the epithet of " sane " ; but 
the fact that the possible is juxtaposed with the absurd 
and that absolutely no means are indicated how to attain 
the possible, is sufficient indication of insanity ; and there 
is no need to refer to Campanella's badly formed skull 
with its seven hills or inequalities, to find it out. No 
inventor or discoverer working in the realms of steam, 
aeronautics, or telescopy could even get a hint of how 
to proceed from reading all the books on Utopia ever 
written. They plainly deal with the unattainable, be- 
cause they have no basis in the facts then known; and 
when the author of " The City of the Sun " claims that 
the citizens of that commonwealth will be invincible in 
battle because they fight for their country, natural law, 
justice, and religion—he speaks of something for which 
no basis will ever be known. 

The sane genius always strives for the attainable, since 
he, better than anyone else, knows both the capacities and 
limitations of human nature. It may take a long time 
and infinite pains — and from this point of view Michel- 
angelo's definition of genius as an infinite capacity for 
taking pains, is perfectly correct— to attain to higher 
levels of social and individual living, but the genius does 
not swerve from the path known to be correct after a 
careful examination of the facts has disclosed the at- 
tainable. Any other road may hold great promises of 
conjectural benefits, but the sane man knows them to be 
spurious, because unattainable, and prefers to work 
slowly toward a goal which will be reached sooner or 
later. If not able to reach it during his own lifetime, he 
is satisfied to open the path for future generations; 
but he will not make promises which are untrue to the 
facts. The long and wearisome search of Darwin 
through almost innumerable details before reaching one 



HEALTH AND ORIGINALITY 263 

conclusion is a good illustration of the respect for facts 
which the true genius has. Every objective genius has 
worked in this manner, and that is the reason why the 
results obtained are substantial and lasting, as well as 
broad and universal. In the objective realm the attain- 
able can be reached only in conformity with the facts, and 
the sane genius knows it better than the less gifted, simply 
because his mental horizon is broader and his insight 
deeper. 

The third criterion of sanity in genius is utility. What- 
ever a great mind may produce must ultimately be tested 
by its applicability to society as it is, even though the 
purpose be to raise men to a higher level. Utility is not 
to be understood here in the sense of market value, but 
in the sense of benefiting society either by inspiration 
through higher ideals or by providing better conditions of 
living. From this point of view there is again a distinc- 
tion between the less and the more objective genius. The 
former may, by the power of rich and facile construc- 
tion, give us joy or consolation through art and litera- 
ture ; and by raising the tone of our mentality, he may 
be very useful to society. But after all, art and literature 
are holiday aflFairs for the great majority of men ; they 
enable us to enjoy ourselves when we are " oflp duty "— 
a condition which to most men is a comparatively rare 
experience. And it cannot be otherwise in the very nature 
of things. What has come so easily to one man cannot 
aflPect other men's lot very deeply. To give joy and 
pleasure is useful; but to increase the means of life and 
to ease its burdens is more useful. And the latter can 
be done only by the hard and constant work of the more 
objective genius. To invent the steam engine or to dis- 
cover the relation between certain parasites and certain 
diseases, requires strenuous application, frequently for 



t: 



if 



ii 






V" 




264 HEALTH AND SOCIAL PROGRESS 

long periods. But the results justify the pains taken, be- 
cause they aflfect the whole of society in its work-days. 
And this is true not only of scientific innovations, but 
philosophical as well. To give the world a well-thought- 
out system of metaphysics, or epistemology, or psychol- 
ogy ; and to make men think clearly and logically, is often 
exceedingly useful even though the whole scheme may 
be out of touch with life; because our whole civilization 
consists of ideas rather than of material possessions. 
Such systems cannot be built up, however, by " inspira- 
tion," but only by close application and the ability to 
sustain mental conflict for a long time. The usefulness 
of the productions of genius is, consequently, always pro- 
portionate to the work involved. 

This implies that the ethical value of work applies to 
the genius as well as to other men. And here we get 
another distinction between the subjective and the ob- 
jective genius. It is certainly noteworthy that the men 
of genius who have gone wrong belong with rare ex- 
ceptions to the former type. Because production is com- 
paratively easy for them, they feel less in need of the 
stem discipline which the scientific worker has to impose 
upon himself. As a matter of fact, the subjective is 
always easier than the objective. And if a man deliber- 
ately chooses the subjective he certainly follows a natural 
instinct along the line of least resistance ; he misses, how- 
ever, a valuable opportunity to develop qualities which 
lie perhaps dormant, but could be developed and would 
make him a greater genius by keeping him in closer con- 
tact with life. And the usefulness of the genius from 
this point of view is very great, since the deeds of the 
men on the heights gradually percolate through society 
by imitation ; and any wrong example is certain to work 
mischief with thousands. The model lives of many 



HEALTH AND ORIGINALITY 



265 



scientists and philosophers are as large an asset from this 
point of view as their work is from another. 

In closing this brief discussion of genius and sanity 
a few other remarks may be made. The objective genius 
requires a certain amount of maturity. It is a striking 
fact that many great men have been pessimistic in their 
youth, e.g., Goethe; while as they reach manhood they 
seem to overcome that stage and become serene if not 
optimistic. This change seems to be due to greater ob- 
jectivity attained through life's experiences. In propor- 
tion as our contacts with life are varied and numerous, 
we seem to gain not only new knowledge but a more satis- 
factory view of life. The pessimist imagines life to be 
very diflFerent from what it actually is. This purely 
subjective attitude can be overcome by larger experience. 
A number of men of genius who did not live beyond this 
period of youthful pessimism, have given us lamenta- 
tions and vituperations about society which have been 
charged to genius as such, whereas they ought to have 
been charged to its youth and immaturity. The young 
man is very sensitive since life has not had an oppor- 
tunity to even up things with him, and judgments are 
formed rashly on the basis of immediate impressions. 
The senses are, moreover, keener than later in life, and 
joys and sorrows make a deeper momentary impression. 
The result is that the whole attitude becomes largely 
subjective, and the " Werther " type of Goethe is de- 
veloped. In proportion as life presents a greater variety 
of experiences which influence the young, there is a better 
opportunity for the balancing of joys and sorrows, and 
the attitude becomes more objective and, therefore, more 
optimistic. 

This immaturity of the young genius may be explained 
also on the basis of intellectual development. The very 



266 HEALTH AND SOCIAL PROGRESS 

young are happy because lifers problems are not realized 
and so none exist beyond those of immediate physical 
welfare ; health is a sufficient reason to insure happiness 
in children. The youth begins to comprehend these prob- 
lems, is unable to solve them, becomes puzzled, and 
sooner or later turns pessimist, especially if health is not 
exceptionally good — a frequent occurrence since young 
men are usually careless of the laws of hygiene. The 
more mature man not only sees the problems, but knows 
how to solve them on the basis of past experiences. 
Hence his general attitude is one of serenity. 

The individual repeats thus the experience of the race. 
The savage, still undeveloped, has comparatively few 
problems, abandons himself to pleasures, and is happy as 
long as the vital functions are undisturbed. The semi- 
civilized man, being more developed mentally, is puz- 
zled by the complexities of life, and his attitude is serious 
on the whole, since he is unable to find solutions for his 
difficulties. The civilized man is aware of the problems 
but is serene, since the history of the race has taught him 
that one difficulty after another has been overcome ; and 
so he is confident that other problems will be solved in 

due time. 

The subjective genius, particularly in his youth, is 
largely in the position of the semi-civilized. Just because 
he is able to see further and deeper, the problems of life 
seem more numerous and complex. Owing to inex- 
perience and to frequent neglect of health, he lacks ability 
to find a solution and the buoyancy of high vitality to 
inspire him with hope. Hence the nimierous pessimists 
among men of this class. 

The objective genius is rarely pessimistic. His very 
vocation calls for discipline in every respect. He must 
have keen perceptions and a clear mind in order to ob- 



HEALTH AND ORIGINALITY 



267 



serve facts accurately ; hence he usually takes good care 
of his health. He has trained himself, moreover, to take 
one step at a time, knowing that this will bring him so 
much nearer to a solution. Success, often moderate 
enough, inspires him nevertheless with confidence that 
complete success will ultimately be attained, and so he 
rarely gives way to useless complaints and lamentations 
— unless he is old and decrepit, a condition characterized 
by inability to accomplish, begetting a disbelief in the 
performance of others. The generally optimistic atti- 
tude of scientists and of the more mature philosophers 
is due to the fact that they have produced something on 
the basis of experience and made it available to others, 
that they have striven after the attainable and made it 
socially useful. Men must progress together. The genius 
who is unintelligible to his fellowmen, might as well not 
have lived; only in proportion as he helps his fellowmen 
to see more clearly, to act more generously and efficiently, 
and to strive more nobly and earnestly, can the genius be 
called sane. And to be sane, he must be healthy. 

Whether genius is subjective or objective, the ex- 
traordinary power for synthesis requires vitality, at least 
if the synthesis is to be coherent and applicable to life. 
While this extraordinary power is characteristic of the 
genius, it is not always combined with facility of syn- 
thesis. Even in the case of the subjective genius great 
endurance is necessary. Newton and Kant could main- 
tain for hours at a stretch a struggle with difficulties 
which would exhaust an ordinary man in five minutes. 
They did this, moreover, day after day, and included a 
vast mass of ideas in their systems. This certainly re- 
quired vitality of a high order. We have seen above 
that Bach and Beethoven had great vitality, although 
musical genius is supposed to compose in a flash or by 



268 HEALTH AND SOCIAL PROGRESS 



inspiration. That may be true. But long hours of high 
tension precede the fruitful flash of creation, and when 
at last the tension is released, the new symphony springs 
fully planned into existence. Hence the exhaustion which 
usually follows one of those creative moments ; hence also 
the frequent abandonment to sensuous pleasures on the 
part of the weaker members of the artistic, musical, and 
literary fraternities after such moments. The fact that 
the highest men of these classes were able to keep their 
equilibrium at such times, is an argument in favor of 
their health, while the abandonment of the lesser men 
argues equally for their lower vitality. For, every new 
creation implies a heavy expenditure of vitality ; and the 
extreme fatigue which overcomes the weaker men, lowers 
— as fatigue always does — their power of resistance and 
they fall into evil ways. 

Richard Wagner — the best timibler and sommersault- 
turner of the large Dresden school and an adept at every 
form of bodily exercise, who could stand on his head 
when near seventy years of age ^** — worked almost in- 
cessantly for a whole month on his Walkiire, although he 
composed with facility. The mere notation of the music 
involved vast labor. Several of his operas have each over 
a million notes. Since the stems are at an axis of 90 
degrees and the five ruled lines of the music paper at an 
axis of 180 degrees, and since the value of the notes is 
almost constantly changing, the mere problem of writing 
them down accurately required not only much strength 
but very close application. Wagner, moreover, wrote the 
libretto and designed the costumes as well as the decora- 
tions for his operas. And all this he had to do with astig- 
matic eyes. Considering that he wrote twelve operas 
beside many smaller works, the conclusion that only a 
man of great vitality could stand the strain is inevitable. 



HEALTH AND ORIGINALITY 



269 



With the objective genius the tension at any one time is, 
perhaps, not so high ; but it lasts longer, often for years, 
and demands the combination of innumerable details in 
many cases. The work of great physicists, chemists, 
naturalists, and physicians requires first of all the mastery 
of many facts, and then a continued application for classi- 
fication, finally a high power of coordination, and the 
scientific use of the imagination if anything new is to 
be produced. This has to be tested and tried to see if it 
works properly and is useful. Much greater accuracy is 
required in such a case, since the innovation must stand 
the tests of other scientists and that of saving or helping 
human beings; e.g., a new medicine or a new electrical 
device. The scientist needs, consequently, an imagina- 
tion of as high an order as the poet and artist, but it has 
to be better trained and must include details. If a piece 
of art is not acceptable, that ends the matter; but if a 
bridge is poorly constructed, hundreds of people may lose 
their lives. Whether the genius be subjective or objective, 
the exertion in creating something new always involves a 
tremendous strain which only men with good vitality are 
able to endure. 

The majority of socially useful great men have been 
strong and healthy. They were neither insane nor de- 
generates. A number of them suffered severely from 
some functional defect, but in every case there was at 
least sound structure, promising good health with proper 
care. Social conventions often required indulgence in 
various vices, and the tremendous strain of creative ef- 
fort led many of the subjective geniuses to seek relief 
along the same channel. Medical ignorance of former 
times was unable to cope with small difficulties and the 
victims of slight diseases became sufferers from their 
accumulated effects. All this has changed. 



270 HEALTH AND SOCIAL PROGRESS 

The genius is no longer required to be a social out- 
cast, nor is he expected to disregard the laws of hygiene. 
Physicians are able now to relieve if not cure smaller 
ailments and to render every possible help to the genius 
as well as to the ignorant. Above all else, our men of 
science have come to recognize the value of health and arc 
taking good care of their bodies; consequently they are 
as a rule not only long-lived but vigorous. Poets and 
artists are gradually following in their footsteps in this 
regard. The general campaign against neglect or abuse 
of the body is slowly affecting all classes, more particu- 
larly the mental workers. This may produce a new con- 
ception of the genius as the physically best-equipped man 
instead of that of a degenerate or insane person. For, 
the genius who suffered did not produce because of suf- 
fering, but in spite of it, by virtue of his strong vitality 
and finely organized brain. His works would have been 
more perfect and wonderful had he enjoyed uniformly 
good health. If we look at the great masterpieces of art, 
literature, philosophy, and science, produced by the hand- 
ful of ancient Athenians, we cannot escape the conclusion 
that the believers in the principle of " a sound mind in a 
sound body" must have been right. Ultimately the 
physically most perfect man must have the best mind. He 
must be as he has always been, closely bound to the 
thoughts of his contemporaries, and incarnate the best 
ideas of his times. 

" He does not create ; he reassembles in one organism 
the scattered members, the medial vibrations of the 
crowd ; he feels and expresses all that is new and beauti- 
ful and great that is in process of formation in the men 
who surround him, who are frequently unconscious of the 
beauty which is in them. . . . The medial intellectual man 
who has produced it [a work of art or of science] is a 



HEALTH AND ORIGINALITY 



271 



I 



beneficent genius to humanity because he aids its upward 
progress by appealing to the better part in each indi- 
vidual." »*• 

Lombroso must have thought of this combination of a 
sound physique with a sound mind when he wrote of the 
sane men of genius as follows : 

" Such have been Galileo, Leonardo da Vinci, Voltaire, 
Machiavelli, Michelangelo, Darwin. Each one of these 
showed, by the ample volume and at the same time the 
symmetrical proportion of the skull, force of intellect 
restrained by the calm of the desires. Not one of them 
allowed his great passion for truth and beauty to stifle 
the love of family and country. They never changed their 
faith or character, never swerved from their aim, never 
left their work half cempleted. What assurance, what 
faith, what ability they showed in their undertakings; 
and, above all, what moderation and unity of character 
they preserved in their lives! Though they, too, had 
to experience — after undergoing the sublime paroxysm 
of inspiration — the torture inflicted by ignorant hatred, 
and the discomfort of uncertainty and exhaustion; they 
never, on that account, deviated from the straight road. 
They carried out to the end the one cherished idea which 
formed the aim and purpose of their lives, calm and 
serene, never complaining of obstacles, and falling into 
but few mistakes— mistakes which, in lesser men, might 
even have passed for discoveries."*** 



CHAPTER XIV 
RESULTS AND PROSPECTS 

In the preceding chapters, emphasis has been placed upon 
the importance of health from every point of view, and 
especially upon the influence of malaria and hookworm on 
civilization. Figures have been given to substantiate the 
statements which were made. The reduction of malaria 
in partictilar was, however, due chiefly to the govern- 
ments which took up sanitation in the tropics because they 
had to protect their own officials sent to the infested 
regions. They needed not to trouble themselves about 
expense, since they had the power of taxation and, in 
many cases, that of military discipline. The areas thus 
taken up would always remain small if private capital 
could not be interested. If disease is to be eliminated, 
or at least much reduced, its removal must be shown to 
be a profitable investment and proof must be given that 
the appeal is made not merely to benevolence but to 
sound business sense. It is the purpose of this chapter to 
give additional data in proof of the proposition that both 
governments and private capital are becoming aware of 
the tremendous opportunities for profitable investment in 
health, especially in torrid regions and farther north 
where endemic diseases prevail. A forecast of what is 
already planned for the future by one private corporation 
will also be necessary to show that the problem of health 
is interesting an ever widening circle of intelligent 
people, 

373 



RESULTS AND PROSPECTS 



273 



THE UNITED FRUIT COMPANY 

The United Fruit Company was organized in 1899. 
Recognizing the necessity of health among its workers, 
the company organized a sanitary and medical department 
in 1900. It is the business of this department to lay out 
settlements for the workers, keep them in sanitary con- 
dition, and instruct the laborers and their families in 
dietetics and hygiene. The plantations are kept free as 
far as possible from mosquitos and other insects. Hos- 
pitals are provided in the different republics, clinics in 
the larger settlements, and physicians in the smaller 
ones. In order to encourage the study of diseases 
which are most frequent in the territories where 
the company's lands are located, it started and sup- 
ported a school of tropical medicine at Tulane Uni- 
versity, La. 

The Company had invested $220,244 in hospitals dur- 
ing 1912, and $451,391 in 1913. From the annual reports 
of the medical department the following interesting 
figures are taken. The author wishes to acknowledge 
the kindness of Dr. W. £. Decks for his valuable as- 
sistance in this part of the discussion. 



Year Hospitals 

1912 10,383 

1913 10,497 

1914 15,406 

1915 12,362 





Death 


Rate in 

Toro 

(Panama) 


Bocas 


ispensanes 


White 


Black 


Total 


53,082 


12 


11.15 


1 1.2 


61,932 


3.33 


77 


7.5 


91324 
83,117 






'U 


Y^ 



\ 



A striking feature is the low hospital mortality rate: 
30 per 1,000 in 1912; 33 in 1913; 26 in 1914, and 41 in 
1915. Another striking feature is the low morbidity rate 



II 



274 HEALTH AND SOCIAL PROGRESS 

in Eocas del Toro; it was lowest in February. 1912, with 
18.36 per 1,000 and highest in August with 28.52. This 
compares well with an average of 33 per 1,000 in the 
United States, even though all ages of the population are 
included in this figure, while for Bocas del Toro we have 
only the workingmen of the company. 

The education of the laborer has been one of the princi- 
pal objects of the company. The worker knows now 
that It is to his interest to obey the rules of the physicians ; 
he has learned that the protection of his health against 
mosquitos is an important matter, and needs but little 
urging to help to wipe out the pest. In pursuit of its 
educational campaign the company has provided schools 
and churches, which have helped to produce a better class 
of labor, since both teachers and ministers preach sanita- 
tion. With a steady and well paid job, a house and a 
garden, chickens and other fowl, the laborers are happy 
and contented. They have varied in number from about 
20,000 with dependents in 1904, to 71,910 in 1914, but 
they have always willingly paid the small monthly contri- 
bution to meet the considerable annual deficit. Accord- 
mg to a letter of September 18, 1916, from Dr. W. E. 
Deeks, the general superintendent of the medical de- 
partment, the relation of the deficit of this department 
to the "operating cost of tropical divisions" was as 
follows : 



Defict of Medical 
7nVf ♦X°**L^2^ Department PcrcentMe 

l^li 19,676,607.84 130.047.16 0^6 

*^'5 16,647,077.19 134,804.73 <x8i 

The reason for the increase of the deficit was the fact 
that fewer laborers were employed in 1914 and 1915, 



RESULTS AND PROSPECTS 



275 



f 



while the overhead charges of the medical department 
remained the same. These statistics prove that san- 
itation in the tropics is not ruinous for private enter- 
prise. 

The men at the head of this company had a large 
vision. They were willing to meet disappointments and 
temporary loss in several branches of the business. Per- 
haps the most difficult task was the( education of the 
laborers, since no military discipline could be resorted 
to, nor importation of Spaniards and Italians. The 
company made it an object to get its working material 
on the spot by educating the natives and negroes. This 
required the arousing of interest on the part of an 
apathetic class of people. It was done by improving the 
health of the workers through sanitation and hygiene, 
because an under- vitalized man is content with few things 
and stops work when these are obtained ; while a healthy 
man has more wants and is able and willing to work 
longer to secure them. The shiftlessness and unrelia- 
bility of the laborer in the tropics is due to poor vitality, 
and an educational campaign must begin with the im- 
provement of health and sanitation. 

The company has found this expenditure good business. 
Its assets in 1900 consisted chiefly in land, of which it 
possessed or leased 236,201 acres in various parts of 
tropical and sub-tropical America; only 66,294 of this 
acreage was improved. In 1913 it controlled by lease or 
deed 1,210,443 acres — ^an area almost equal to the state 
of Delaware— of which 331,344 acres were improved. It 
has established a number of towns and cities, steamship 
lines and railroads with terminal facilities; it controls 
a large share of the exports and imports of various 
smaller states, and has paid over ten per cent in annual 
dividends, besides putting a large share of the earnings 



I 

pi 



276 HEALTH AND SOCIAL PROGRESS 

back into the business, and accumulating a surplus of 
$16,284,211 by September, 1913* 

The occupation of the tropics may seem a formidable 
undertaking. So was that of our own continent. Little 
did the 5,000,000 people of this country dream in 1800 
that by 1900 we should have occupied all the land be- 
tween the Atlantic and the Pacific. We increased our 
farm area from 1850 to 1900 by 463.000.000 acres, an 
average of 25,000 acres daily. The new farms occupied 
and improved within these fifty years are greater in 
area than Germany, France, Italy, England, Scotland, 
Denmark, Belgium, Ireland, Holland, and Switzerland 
in the aggregate. It was the love of adventure and 
abounding health that made us do it. Necessity will 
compel us to do in the tropics what we have done at home. 
In two or three centuries the increased population of 
the world will cry for bread, and the tropics will have to 
furnish it— if the world can wait that long. We shall 
have to do it, and we already have the means. 

Perhaps the principal foods for the white race will 
always be produced in the temperate zones. But we 
have constantly extended the area of cereals further 
north. In a few decades, varieties of wheat, rye, and 
barley have been profitably produced by scientific selec- 
tion in Winnipeg and further north. No one supposed 
fifteen years ago that Alaska would produce a variety of 
cereals ; yet, in 1914, the harvester was singing its song 
along the Yukon River. Another variety of wheat has 
been produced which yields excellent crops on the 
formerly arid lands of Colorado, Idaho, and Wyoming. 
Even the desert lands of southern California and Arizona 

aI^ TtfSV'^'^i! ^fJH ^:?^*«* by Frederick Upham 
^ff"»' ^«Wc<»*y. Pafi^ & Co., New York, 1914, for » com- 
plete deicnption of this company, ~» ^ •»» 



I 



RESULTS AND PROSPECTS 277 

have opened up their wonderful resources at the magic 
touch of irrigation. 

With these facts before us, it is entirely within the 
range of probability that cereals and even cattle will be 
adapted to lower latitudes in the course of time. The 
tropics and sub-tropics will undoubtedly furnish a larger 
amount of food for the population of the future. Scien- 
tific selection is a young though lusty branch of knowl- 
edge. What it will achieve in a century, no man now 
hvmg can tell. We are no longer subject to nature; 
we have mastered her in many ways, and our control over 
her forces is growing constantly. Telic civilization has 
taken the place of genetic development. We know what 
we want, and adapt ways and means to satisfy our needs 
The forces of nature controlled development in the past • 
m the future man will control his own fate. Climatical 
and geographical features are becoming less important 
every day. Perhaps General Gorgas may prove right 
after all m claiming that civilization is drifting back to the 
tropics. He states * that man could travel faster than the 
inicrobes, and thus reached healthy regions in higher 
latitudes where he could live and be well, after the dis- 
covery of fire and clothing. Now he has discovered how 
to go back to the tropics by controlling the diseases which 
drove him out. The increase in population will certainly 
compel man to obtain more food there by improving the 
health of those countries. 

SOUTHERN UNITED STATES 

When the Rockefeller Sanitary Commission began its 
work for eradicating hookworm in the Southern States 
much opposition had to be overcome and an educational 

• Of, cit, p. 286 ff, 






278 HEALTH AND SOCIAL PROGRESS 

campaign had to be carried on in order to show that the 
work was imperatively necessary for the health and wel- 
fare of the people. As soon as the results proved the 
importance of the work done, legislatures became more 
deeply interested and appropriated money more liberally 
for the purpose of improving sanitary conditions. The 
appropriations increased from $255,395 in 1910 to 
$1,416,111 in 1918. This made possible the treatment 
of an ever larger number of hookworm and malaria 
victims, but what is more significant is the reduction 
in the cost of treatment per patient. In 1910, for 
hookworm patients, it was $4.66; in 1911, $1.05; 
in 1912, $0.72, and has since that time been kept 
low. 

A striking illustration of the effect of practically rid- 
ding a community of malaria is furnished by the report of 
the International Health Board for 1918. The town of 
Hamburg, Arkansas, has a population of 1,285. In 1916 
there were 2,312 physicians' calls for malaria; in 1917, 
after the Board had been working for one year, there 
were 259 ; in 1918, only 59. The reduction from 1916 to 
1918 was 97.4 per cent. The per capita cost was reduced 
from $1.45 in 1917 tQ $0.44 in 1918. The demonstra- 
tion of the feasibility and economic value was so com- 
plete that Hamburg took over the entire cost of the work 
at the end of 1917, having paid only 33 per cent of the 
expenses in 1916 after an educational campaign had con- 
vinced the people of the necessity of the work. At $2.00 
per physician's call this community paid in 1916 alone 
$4,624 — ^a sum several times larger than it paid in the 
two following years to get rid of malaria and the mos- 
quito as a pest. This case is only one out of many in 
various parts of the South ; everywhere a comparatively 
small outlay made under the direction of experts was 






RESULTS AND PROSPECTS 279 

sufficient to practically exterminate malaria by controUiiwr 
the breeding-places.* 

«;,17'" """•'""«»"' f°' hookworm disease made among Umted 

S'ror^rLrf ""'' '" • '^"""'^ *"' ** board-,* expen. 
enceof the last few years, and demonstrated that even »riit 

"Tu^eTh ""/rr "c- °' '^"" •'"PO't'nce," says Zr^ 
Jh.? i! ^' Bmet-S.mon and other tests, many full-™ 
m^u H, ? "^'"^ comparatively few hookwo^s had X 
menuhty of persons only 12 years of age. The mentality of 
io,ooo white men at Camp Travis who harbored the d^feaL 
was about 33 per cent below normal. Negroes were infc^.^ 
quite as frequently as whites, but they appea^^^d toTreuS 
mmune to the serious effects of the disease and m not show 

* mrjiir"'~""°" '° °''" ''""" "' ''' »- "^"*" 

in' Qu'Jinlla^f a' ? "^'^'u """'' ""°"« ^ ^°°' ^^'-Iren 
rL:I>? . ' ^"''"''"' showed that there was an average 
retardation of approximately two years among heavily taftSfd 

t rmrda^c^i '"T "' ^'^""^ Persisted^he grLT/'^s 

were"ta1cen"^„!^ Th"^'' ?^ ninety-nine highly infected soldier, 
were taken upon their entrance to the army, and again at the 

wTriz^' f T.j''"'*!?"^' ''^'^-"'- of th-e-ldi*: 

were treated for hookworm disease, and the other thirty re- 
mined without treatment. Those who were treated ^^ 
«n average of ia6 pounds in a period of one year- Aosf w^ 
were not, an average of only ,., pounds "'"' 

"In Costa Rica sixty-six laborers before being treated for 
hookworm disease normally cultivated s6i IcrW^ I 
n.onA,y. After being treated for hoo^o™ di^i they'^!^ 
vat^ 7SO acres, resulting in a net monthly increase i7wt^ 

^it^„r T' '"" ""°'^"« f°' '^ '5 per cent redurtio^^ 
unit pay. Moreover, m India. Clayton Lane reports that th^ 



§ 



280 HEALTH AND SOCIAL PROGRESS 

the laborers were treated; while reports from British Guiana 
indicate that the efficiency of the laborers employed by one 
company increased from 25 to 50 per cent after hookworm 
measures were put into operation.*' 

FOREIGN COUNTRISS 

In Brazil, the Federal and six State govcnuncnts made 
approximately $750,000 available for hookworm con- 
trol alone in 1918. 

In India, the percentage of infection among the runil 
population often ranges from 80 to 100. In the province 
of Bengal alone 30,000,000 of the 45,000,000 population 
are infected. From this country the infection is carried 
to many parts of the world by coolies and travelers. The 
government has at last recognized the economic im- 
portance of the disease and has entered into an arrange- 
ment of cooperation with the International Health Board 
for carrying out a demonstration in control measures 
in the province of Madras. 

In Ceylon many communities and plantations are now 
engaged in stamping out the disease, and are paying more 
attention to sanitation and hygiene. 

Other countries in which work is done for the elimina- 
tion of hookworm disease are: Siam, China, Java (with 
an average infection of 93 per cent), Guam, Jamaica, and 
practically all of the other parts of the West Indies, 
all of the Central American States, the Fiji Islands, 
the SeycheUes, and Papua. In 1917, Jamaica ap- 
propriated $12,000 and Papua $5,000 for this pur- 
pose. 

It is most fortunate that the International Health Board 
has taken up the eradication of malaria in connection with 
that of hookworm, since in most tropical and sub-tropical 
countries and further north, the two diseases go hand io 






RESULTS AND PROSPECTS 281 

hand, infesting the same persons either simultaneously or 
successively. 

OTHER DISEASES 

The practical elimination of yellow fever, except in a 
few breeding-places, needs only to be mentioned. Ty- 
phoid fever is likewise nearly extinct where control is 
complete ; e.g,, in the United States army and navy. For 
less controlled populations, the results are at least en- 
couraging. Virginia reduced its morbidity rate from this 
disease from 14,400 in 1909 to 5,038 in 1917. 

Among the poor people represented by the Industrial 
Department of the Metropolitan Life Insurance Com- 
pany, the death rate from tuberculosis was reduced from 
203.0 in 1911 to 172.8 in 1916 per 100,000. 

Wherever scientific study has been applied to diseases, 
a diminution of mortality and morbidity rates has re- 
sulted, irrespective whether it is done in the forest jungles 
of Brazil or in the steel mills of Pittsburg. The United 
States Steel Corporation spends vast sums of money on 
welfare work, chiefly for the improvement of health. The 
Illinois Steel Corporation finds it economically profitable 
to spend $1,000,000 a year in the protection of its work- 
ingmen against disease and accidents. 

The Metropolitan Insurance Company voted $100,000 
to the National Tuberculosis Society a few years ago to 
establish a " health town " and the result is reported by 
American Medicine for November, 1919, as follows: 
"When level-headed insurance directors spend such a 
large sum of their company's money, they naturally ex- 
pect it to bear interest, however indirectly it may be. 
Framingham, Mass., was chosen for the experiment. The 
leading spirits of the town, level-headed business men, 
saw a good opportunity for investing the town's money,' 



282 HEALTH AND SOCIAL PROGRESS 

and raised the per capita expenditure for public health 
from 39 cents to $L00. The purpose of this ex- 
periment was to show that in many cases sickness and 
death, particularly tuberculosis, can be eliminated by 
medical treatment and careful nursing, personal hygiene 
and adequate health administration. The experiment 
proved an unqualified success. In 1916 before the ex- 
periment was begun, 81 babies per 1,000 died; dur- 
ing the first year of the experiment this was promptly 
reduced to 61 per 1,000. Previous to the inauguration 
of health conditions in this town of 16,000 souls, 121 
persons died in one year from tuberculosis. In the first 
year of the test this was reduced to 99 deaths, in the 
second year to 79, in the third year to 76— and this reduc- 
tion occurred while the town increased in population. At 
the end of three years the town leaders were well satisfied 
that their investment of 61 cents excess tax for health 
was an exceedingly profitable one. The directors of the 
insurance company felt that their $100,000 experiment 
was beginning to pay them better than if it had been 
sunk in first mortgages. Health towns, it was discov- 
ered, paid. The health of babies and adults was actually 
an " asset," which could be measured in dollars and cents. 
We beg the indulgence of legislators for our carelessness 
in overlooking these facts and for sentimentally regard- 
ing the health of babies and adults merely from a humane 
point of view." 

Much more needs to be done. If private corporations 
find such large expenditures for health profitable, the 
country as a whole will do so, too; indeed, the world 
as a whole will. For, the world as a whole is concerned 
in this matter, not excepting our own country. While 
this treatise has been concerned chiefly with two endemic 
diseases prevalent in southern latitudes there is no special 



RESULTS AND PROSPECTS 



283 



reason why we should be in an exultant mood. Our 
country received a rude shock when we learned in 1917 
that out of about 1,300,000 volunteers for the army and 
navy only 448,859 were physically qualified, the rejections 
being 66 per cent. Some of these were later drafted; 
but even if 50 per cent of our young men should be found 
physically unfit for military service, the percentage would 
be uncomfortably high. These figures were later reduced, 
as will be shown. It was, perhaps, this revelation which 
started several new movements for improving the health 
of mankind, chiefly that of the Red Cross. 



PROSPECTS 

The International Health Board is planning to extend 
its activities during 1919. In addition to its work against 
yellow fever, hookworm, and malaria, the Board will in- 
clude tuberculosis in France, for all of which an appro- 
priation of $2,367,130 has been made. Medical education 
will receive $3,726,504, part of which will be spent in 
China, and the Medical School of Johns Hopkins Uni- 
versity has received an endowment of $10,000,000 from 
Mr. Rockefeller for the study of prophylactic medicine. 
Work against hookworm and malaria will be done in 
twelve Southern States and in twenty-one foreign coun- 
tries. 

During the draft of 1917 and 1918 about 3,208,000 
men were examined, of whom 521,606 or 16.25 per cent 
were utterly unfit for any military service whatsoever. 
A comparison of the age groups of registrants showed 
that 76.89 per cent of those aged 21 were physically fit, 
and of the age group between 21-30 only 69.17 per cent 
were fit. Of such a select group of men as college students 
are supposed to be, one in every four was physically dia* 




284 HEALTH AND SOCIAL PROGRESS 
qualified for full military duty. The obviously unfit and 
many others who had dependents were, of IZ! ^t 
«cam.ned, and the statement made previouslyXr^b^ 

qualify for fuU mUitary service, seems to be aooroxi 
mately true, especially since nothing is said rbouftC 

lact that the Federal Government has been forced f„ 
face the situation of a large amount of ill hLl S L Jj 
country, especially among the men who should be ^s 
vgorous. Perhaps millions of men with remtl^ht 
diseases will be restored to health, and oti r m^E^S 
be kept m good health by the introduction of proZ aS 

zt:::::^ r ""'•'*= »•-'* ^^^- whKe^'S! . 

tary strength of a country is at stake, the government 
usually acts just as the English Parliament aSed ™ 
similar revelation during the Boer War 

fnJl^S^'^u'T!^ '* inaugurating a world-wide movement 
for public health. An International Committee of Td 
Cross Societies was organized in April. 1919 with th. 
for«„ost specialists of the medical and sanitarl * 

united btates, as members. RepresentativAc r.f *u 
countries will be elected as soon Z^Z t^Z 
IS to have a central office in Geneva. Switzerland whkh 
s to serve as a clearing house on all matters of healtJ^anl 
sanitation. Any „ew discovery in curative or pr^* «ve 
medicine will be communicated to this office and XmT 
nated from there all over the world. Anything £ c^n 
tnbutory to health will receive the doselt ».ll T' 
since the work is to be prophylact.^ ttr T^ 

methods. The results to be attained a., 'briefly t 



RESULTS AND PROSPECTS 



285 



First — Owing to the close international relations 
through commerce and migration, diseases are now 
spread from some obscure corner of the world to other 
countries. The work proposed would arouse the peoples 
of every country to a sense of their obligation to their 
fellowmen, and there would naturally follow in each 
country an awakening to the needs within its own 
borders, and a determination to meet them as far as 
possible. 

Second — It would throw light on the darkest comers of 
the earth, and would give to all the world the full benefit 
of scientific study and experience in the cure and pre- 
vention of disease. 

Third — It would make possible the immediate coopera- 
tion on the part of various organizations to render aid 
when necessary in the case of great disasters. 

If such an organization had been operative in 1917 
it is probable that the influenza epidemic could have 
been confined to its source in China, that several 
millions of lives would have been saved, thousands of 
others would have been spared its weakening effects, and 
untold misery prevented. 



Whatever aspect of health is considered, it has an im- 
portant bearing on social progress. The men of genius 
who have given to the world the vital ideas which have 
made civilization possible, were healthy men. Progres- 
sive nations could live only in regions which permitted 
at least a fair amount of health. The increasingly greater 
need for food will compel the nations of the north to 
make the countries of the south sanitary. The many 
serious ailments from which society suffers, will be 
largely alleviated, if not removed, by greater attention 



286 HEALTH AND SOCIAL PROGRESS 

to health. It is within human power to turn our social 
destiny by more diligent application of scientific dis- 
coveries already made and others soon to come, into 
paths of health and happiness. A gift of $50,000,000 
was announced January 1, 1920, by Mr. Rockefeller 
for the scientific extension of work on health all over 
the world. This will enable mankind to apply the 
medical discoveries already made more widely, and to 
pursue the search for health more generally. A new 
era is thus dawning in which health will be considered 
one of the most important assets of society. 






i\ 



I 



, 



NOTES 

Explanation: The notes throughout the book are numbered 
consecutively. The numbers have no reference to pages. 

^Influence of Geographic Environment, by Ellen C. Semple; 
Henry Holt & Co., New York, 191 1, p. 2. 

^The Efficient Ufe, by Luther H. GuHck. M.D.; Doubleday. 
Page & Co., New York, 1907; pp. 177 and 178. 

« Secret of Hegel, by J. Stirling, Vol. H, p. 554. 

*The Play of Animals, by Karl Groos; D. Appleton & Co., 
New York, 1898. 

^Inductive Sociology, by F. H. Giddings, p. 252. 

*The Aristocracy of Health, by Mary Foote Henderson; 
Harper & Brothers, New York, 1906; p. 6. 

"^Inductive Sociology, by F. H. Giddings; pp. 257 and 259. 

* Hereditary Genius. Macmillan & Co., London and New 
York, 1892; p. 271. 

• See Dr. H. K. Carroll's article in the New York Christian 
Advocate, January 30, 1913, on "Statistics of the Churches of 
the United States — 1912." 

10 Body and Mind, by Henry Maudsley, M.D. ; D. Appleton & 
Co., New York, 1884; pp. no and iii. 
^^ Growth of the Brain, by Henry Herbert Donaldson; Chap. 

^* Maudsley, op, cit., p. 38. 

^* Pure Sociology, by L F. Ward; pp. 267-272. 

^^ Politics, Book I, Chap. VL 

^^ Inductive Sociology, p. 252. 

^*The Theory of the Leisure Class, by Thorstein Veblen; 
The Macmillan Co., New York, 1908; p. 15. 

*^ Inductive Sociology, pp. 259 and 260. 

"/< Practical Study of Malaria, by Wm. H. Dcaderick, M.D.; 
W. B. Saunders Co., Philadelphia and London, 1909; pp. 17 
and 19. 

^•Tropical Diseases, by Sir Patrick Manson; Wm. Wood & 
Co., New York; p. 68. 

*• Ibid., p. 70. 

»i Ibid., p. 70. 

*^Ibid., p. 72. 

25 Deaderick, op. cit, p. ^37. 

2* Ibid., pp. 29^-297- 

" Ibid., p. 298. 

*• Manson, op. cit., p. 1091 

^"^ Ibid., p. no. 

^* Malaria: A Neglected Factor in the History of Greece emd 
Rome, by W- H. S. Jones, M.A.; "Introduction** by Major R. 

a87 



'& 



■ffir 



288 



NOTES 



Ross, F.R.S.; "Concluding Chapter" by G. G. Ellctt, M.B.; 
Macmillan & Bowes, Cambridge, England, 1907; p. 7. 

2» Manson, op. cit., p. 102. 

•oDcaderick, op. cit, pp. 31-33. 

•iDeaderick, op. cit., pp. 22 and 23. 

^Influences of Geographic Environment, by Ellen C. Semple; 
Henry Holt & Co., New York, 1911; pp. no and in. 

^^ Hereditary Genius, by Francis Galton, F.R.S. ; Macmillan 
& Co^ London and New York, 1892; p. 329. 

•* Galton, ibid., p. 331. 

••Jones, Malaria and Greek History, pp. 15 and 16. 

5« Major Ross, in Jones, Malaria, p. 4. 

87 Handbook of American Indians. Bulletin 30 of Bureau of 
American Ethnology, Washington, D. C, 1910, Part II, p. 286. 

^^Sociological Papers, London, 1904; article "Eugenics: Its 
Definition, Scope and Aims." 

^* Malaria and Greek History, by W. H. S. Jones, M.A., 
University Press, Manchester, 1909; pp. 12 and 13. 

*® Jones, Malaria, p. 11. 

*i Lectures on Tropical Diseases, by Sir Patrick Manson, M.D. ; 
W. T. Keener & Co., Chicago, 1905; pp. 103 and 104. 

*2Ross, in Jones, Malaria^ p. 7. 

« Deaderick, op. cit., p. 20. 

** Tropical Diseases, p. i. 

*• Report on the Prevention of Malaria in Mauritius, p. 51 ; 
quoted by Jones in Malaria and Greek History, p. vi. 

*« Malaria and Greek History, p. 23. 

^"^ Ibid., p. 27. 

^^Ibid., p. 34. 

«/6id., p. 16. 

»<> Ellett, in Jones, Malaria, pp. 94*^ 

^^ Malaria and Greek History, p. 55. 

« Ibid., p. 97. 

•3 Ibid, p. 102. 

•* Jones, Malaria, pp. 95 and 96. 

»5 Deaderick, op. cit., pp. 28 and 29. 

^^ Malaria and Greek History, p. 11. 

•^ Jones, Malaria, p. 41. 

^^ Encyclopedia Britannica, nth ed.. Vol XVI, article Latium. 

••Jones, Malaria, p. 66. 

•o/Wd., p. 85. 

•1 The Effects of Tropical Light on White Men, by Major 
Charles E. Woodruff; Rebman Company, New York, 1905; 
p. 224. 

^^Ibid., p. 239. 

*^ Encyclopcedia Britannica, nth cd.. Vol. XVIII, p. 915; article 
" Mauritius." 

^Malaria and Greek History, p. 48. 

*^What Have the Greeks Done J or Modem Civilisation f by 
John P. Mahaffy; G. P. Putnam's Son, New Yprk, 1909; p. 209. 



NOTES 



289 



•« The Races of Europe, by William Z. Ripley ; D. Appleton & 
Co., New York, 1899; p. 259. 

•^ The Effects of Tropical Light on White Men, by Major 
Charles E. Woodruff ; Rebman Company, New York, 1905. 

«8 The Hookworm Disease, by George Dock, M.D., and Charles 
C. Bass, M.D. ; C. V. Mosby Co., St. Louis, 1910; pp. 19-32. 

«• Rockefeller Sanitary Commission for the Eradication of 
Hookworn Disease; Washington, D. C, 191 1; Publication No. 6, 
pp. 26 and 27. 

^0 Rockefeller Sanitary Commission, etc., 191 1 ; Publication No. 
5, p. II. 

'^ Dock, Hookworm Disease, p. 183. 

72 Hygienic Laboratory, Bulletin No. 10, Washington, D. C, 
February, 1903, p. 45 ("Prevalence and Geographic Distribu- 
tion of Hookworm Disease in the U. S.," by Charles Wardell 
Stiles, M.D.). 

73 Uncinariasis (Hookworm Disease) in Porto Rico, by Bailey 
R. Ash ford, M.D., and Fedro Gutierrez Igaravidez, M.D. Senate 
Document No. 808, 61. Congress, Washington, 191 1; pp. 89 
and 90. 

7* Rockefeller Sanitary Commission, etc. Publication No. 6, 
p. 7?. 

»• Rockefeller Sanitary Commission, etc. Publication No. 6, 
p. 7. 

7« Rockefeller Sanitary Commission, etc. Publication No. 5, 
pp. 120 and 121. 

T» Rockefeller Commission, etc Publication No. 5, pp. 113- 
126. 

78 Dock, op. cit., p. 97. 

7»Ashford, op. cit., p. 4. 

•oAshford, op. cit., p. 6. 

•^ Ash ford, op. cit., p. 7. 

•2 Ash ford, op. cit., p. 11. 

•8 Anemia in Porto Rico, Preliminary Report, 1905, p. 25. 

^* Report of the Governor of Porto Rico for 1013: statistics 
on pages 145 to 152. 

85 Annual Report of the Department of Health of the Isthmian 
Canal Commission for igo6, pp. 4 and 5. 

8«Ashford, op. cit., p. 205. 

^^ History of Philosophy, by Alfred Weber; Charles Scribner's 
Sons, New York, 1896; pp. 519 and 520, 

88 The Mind of Primitive Man, by Franz Boas ; the Macmillan 
Company, New York, I9n ; pp. 16 and 17. 

8» Influence of Geographic Environment on the Basis of Ratsel's 
^ystem of Anthropo-Geography, by Ellen Churchill Semple; 
Heni7 Holt & Co., New York, ipn ; p. 40. 

, . *? Rockefeller Sanitary Commission, Publication No. S ; " Ex- 
hibits. Photographs." Figures 2. 7 and 8. 

^^ Influences of Geographic Environment, etc., p. 42. 

w Oscar Peschel, The Races of Man; Appleton & Co., New 



290 



NOTES 



York, 1868; p. «7. pages 308 to 318, discussing "The Zone of 
the Founders of Religion." 

J^^Sociaf Evolution, by F. Stuart Chapin; The Century Co., 
New York, 1913 ; pp. 160 and 165. ' * 

AT^^r^nJ^"*^.^^*^^'^^*'^ *^ £«y/aiid, by H. T. Buckle. 
Vol, I, Chapter II; London, 1857-1861. ^ ^ ^ 

••Ashford, op. cit., p. 7. 

**R"°>5*'^T^*'LY/"^?"l Jhompson, M.D., in Brain and Per- 
^^^i!}! vI^o<l,l ^lead & Co.. New York. 1910; p. 51. 
^'\^ Growth of the Broin by Henry Herbert Donaldson; 
Charles Scnbner's Sons, New York, 1897; p. 352. 

»« Boas, op. cit., p. 24, 

^""The Effects of Tropical Light on White Men, by Major 
Charles E. WoodruflF, M.D. ; Rebman Co., New York and Lon- 
don, 1905; p. 265. 

llr )l^^^f»ff' op' «■'•* pp. 153 and 154. 
^^^Ibtd., p. 158. 

W2 Expansion of Races, by Charles E. WoodruflF, M.D. : Reb- 
man Company, New York, 1909; p. 274. 

^^^ The Military Surgeon, August, 1912, pp. 162 to 166. "The 
Relative Resistance of Blonds and Brunettes to the Harmful 
Influences of a Tropical Qimate." See also "Tropical Sun- 

Ipt' V^. £S N^o 6""' "^ ^^^-^^^ ^^''"^^ ^^"^^'^^ J"-' 

io« ivitaf Have *f^ Greeks Done for Modem Civiligationf by 
John Pentland MahaflFy ; G. P. Putnam's Sons, New York, 1909 ; 

lol S^ 5^'f ^ ^•'''^^l' KY^' Z. Ripley, pp. 407 and 408. 

10* Weather Influences, by Edwin Grant Dexter, Ph. D. ; The 
Macmillan Company, New York, 1904- p 75 
^^^ The Races of Mtin: An Outline of ' Anthropology and 
Ethnography, by /. Deniker, ScD.; Charles Scnbner's Sons, 
New York, 1907; p. 145. 

«rVt!£"t^'''?fu*'* cu"^"''Jf'''w"iJ** «^»^»°"' ^•^icle "Malaria," 
written by Arthur Shadwell, M.D., and Harriet L. Hennessey. 

"» Semple, op. cit., p. 626. 

*" Semple, op. cit., pp. 560 and 561. 

Ma^arta, by Graham E. Henson, M.D. ; C. V. Mosby Com- 
pany, St. Louis, 1913 ; p. 25. 

J" Report on National Vitality, by Irving Fisher ; Washington, 
Government Prmtmg Office, 1909; p. 16 

^^J Municipal Government, bv Frank J. Goodnow, Ph.D.; 

tf.£?*Hn^ .9®™Pany, New York, 1909: p. 25. 
^nno. CAo/fcnye of the City, by Josiah Strong; New York, 
1909 » P» lo. 

rHU^P"^* ?f .*^^ J>fp(irtment of Sanitation of the Isthmian 
{.anal Commtsston for igu; Washington, 1913; pp. 5, 6 and 7. 



NOTES 



291 



^^* Encyclopedia Britannica, nth ed, Vol. XVII, pp. 464-s; 
article " Malaria." yy -^^^ 

^^^ Encyclopcedia Britannica, nth ed., Vol. XV, p. 13, article 
" Italy," section " Malaria." 

12® The Isthmian Canal, by H. H. Rousseau ; Washington, 
Government Printing Press, 1910; p. 45. 

121 The Popular Science Monthly, September, 1913, Vol. 
LXXXIII, No. 3, p. 298. (This magazine has changed its title 
to "The Scientific Monthlv," and should not be confused with 
the Popular Science Monthly of to-day.) 

"2 The Survey October 5, 1912. Vol. XXIX, No. i, p. 47. 

^'* Health and Longevity Through Rational Diet, by Dr. 
Arnold Lorand; F. A. Davis Company, Philadelphia, Pa., 1913; 
pp. 7 and 8. 

12* Lorand, ibid., p. 7. 

"» Woodruff, Effects of Tropical Light on White Men, pp. 
345 and 346. 

i*« Woodruff, Expansion of Races, pp. 309 and 310. 

^^'f Expansion of Races, 2. 309. 

«» Walter H. Page, "The Hookworm and Civilization," in 
The World's Work, September, 1912. 

"• " The Sanitary Awakening of a Nation," Presidential Ad- 
dress by Charles P. Wertenbaker, United States Public Health 
Service, The Military Surgeon, November, 1912, pp. 491 and 492. 

^^^The Insanity of Genius, by J. F. Nisbet; New York, 
Charles Scribncr's Sons, 6th ed., 1912, p. 1S4. 

^^^ Biographic Clinics, by George M. Gould, M.D.; F. Blakis- 
ton's Son & Co., Philadelphia; 3 vol., 1903, 1904 and 1905. 

^^^ Life and Letters, p. 107. 

"•Weber, History of Philosophy, p. 435. 

*»* Ktmo Fischer, Hegel, Vol. 1, p. 214. 

i«» Nisbet, of. cit., pp. 271 and 272. 

"« The Prolongation of Life, by Elie MetchnikoflF; G. P. Put- 
nam's Sons, New York, 1906; p. 261. 

*«^ The Man of Genius, by Cesare Lombroso ; Charles Scrib- 
ner's Sons, New York, 1908; pp. 354-356. 

"• " The Physical Beethoven," in the Popular Science Monthly, 
March, 1914. 

"• " The Intellectual and the Physical Life," Popular Science 
Monthly, July, 1913. 

^*^ Social and Ethical Interfretations in Mental Development, 
by James Mark Baldwin; Macmillan Company, New York, 
2nd ed., 1899; p. 168. 

"lP"o*cd from The City of the Sun, by Lombroso, op. cU., 
p. 288. 

**2 Rogers, Popular Science Monthly, July, 1913 ; p. 55. 
^*^ Pedagogical Anthropology, by Maria Montessori ; Frederick 
Stokes Company, New York, 191 3 ; p. 469. 
*** Lombroso, op. cit., p. 353. 



t 



INDEX 



Actinic ray theory of Wood- 
ruff, 114, 142, 169 

Adenoids, 25 

Alexandria, culture of, due to 
health fulness, 118 

Altitude and health, 190 

Altruism, 30 

Anophelines, carriers of ma- 
laria, 98 

Biology and health better- 
ment, 9 
Brain, development of, 27 
Brain weight, 166 

Cephalic indexes, 167 
Christianity, ideals of, 36 
Church attendance, yj 
Cities, health, 209; growth, 212 
Classical world, effects of ill 

health upon, 11 1 
Climate, 44, I54 
Crime, explanation of, 50 

Dcaderick, William H., 83 
Diet, in relation to energy, 222 
Disease, meaning of, 20 

Egjrpt, endenvc diseases ex- 
plain rule by foreigners, 204 

Endemics, 14, 192 

Energy, 19; diverted by bodily 
disorders, 25 

Epidemics, 14 

Eugenics, 9 

Food, 23 ; variety of necessary, 
222; zones of production, 
276 



Freedom, relation of health to. 
189 

Geophagy (dirt-eating), 176 

Genius, origin, 241 ; defined, 
242; relation to health, 245; 
originality, 256 

Golden Rule, the, 35 

Greece, malaria probable ex- 
planation of deterioration of, 
8, 100 

Health, defined, 15 ; factors of, 
43 

Health department, need for 
national, 239 

Health habits of ancient races, 
7 

Hegelian theory of progress, 
143 . 

Heredity and health, 44 

Hindoos, superstitions of, 153 

Hookworm disease, geographi- 
cal distribution of, 124; 
physical effects, 128; mental, 
129; moral, 130; economic 
and social, 131 ; on Porto 
Rican coffee and sugar 
plantations, 136; statistics of 
mental retardation caused 
hy, 279; governmental aid 
for control of, 280 

Housing, 213 

Hygiene, prophylactic work of, 
9 

Ideals, national, 59 
Industry and health, 10 
Infant mortality, reduced by 

municipal health measures. 

282 
Influenza, 285 
Instinct, 46 



993 



«94 



INDEX 



International Health Board, 

283 
International law, origin of, 55 
Internationalism, of science, 

commerce and politics, 235 

Leisure. 53 

Light and racial development, 
"4 

Malaria, 83; geographical dis- 
tribution of, ^; types of, 
85; disseminated by mos- 
quitos, 91 ; effects of, 122 ; 
extirpation of, 213 
Malnutrition and morality, 51 
Mentality and health, 26, 41 
Migrations, motives for, 199 
Morality and sociali^, 30, 39 
Mosquitos, carriers of malaria, 
91 ; yellow fever, 174 

Nature-peoples, 14, 43, 64 
Nerves, 20 
Nutrition, 26 

Objectivity, test of sanity in 
genius, 257 

Pain, explanation of, 20 
Parasites, factor in man's 

struggle for existence, 3 
Patent medicines, psychology 

of, 184 
Persecutions, explained on 

basis of health, 191 
Peschel, theory of influence of 

environment on religion, 

151 
Pessimism, in subjective gt- 

ius, 265 
Philanthropy and the church. 

Physical economy, 23 
Pigmentation, protective, 167 
Play. 24 
Population, world's increase 

of, 218 
Porto Rico, hookworm disease 

in, 133 ; malaria in, 137 



Progress, five laws of, 77 
Progress, theories of, 143; 
transcendental, 142 ; his- 
torical or accidental, 144; 
natural or geographical, 145 ; 
anthropological, 166; actinic 
ray, 167; explained on basis 
of health, 178; continuity 
and extension of essential, 

193 
Prophylaxis vs. cure, 40 
Psychology and health better- 
ment, 9 

Ratzel-Semple theory of prog- 
ress, 145 

Red Cross, international health 
movement, 284 

Reed, discoverer of yellow 
fever mosquito, 174 

Religion and physical environ- 
ment, 151 

Religions, ideals of, 33, 36 

Revolutions, why frequent in 
tropics, 186 

Rockefeller, John D., gift for 
extension of health work, 
286 

Rockefeller Sanitary G)mmis- 
sion, 277 

Rome, malaria introduced into, 
106 

Ross, discoveries in malaria, 85 

Sanitation, in tropical coun- 
tries, 213; conducted by pri- 
vate enterprises, 273 

Sanity, three tests of, 257 

Sciences and health, 8 

Sickness, racial, 28 

Social nature, the, 75 

Sociality, 51 

Sociology, concerned with 
health, 9 

Spiritual importance of health, 
8 

Stegomyia (yellow fever mos- 
quito), 174 

Strain, physical and mental, 243 



INDEX 



295 



Superstitions, origin of, 185 

Tropics, health conditions, 124 ; 

causes of moral laxity, 154; 

sanitation, 213; government 

in, 229 
Transcendental theory of 

progress, 142 

Uncinariasis (hookworm dis- 
ease), 124 ff. 

United Fruit Company, sani- 
tation conducted by, 273 



Utility, test of sanity 
genius, 257, 263 



in 



Vital statistics of modern 
countries, 206; increasing 
span of life, 237 

Vitality, 17; necessary for so- 
cial action, 29 

Work, factor in civilization, 

, 65 

Woodruff, actinic ray theory, 
167 



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